Reconstruction of injured autonomic nerves in the abdominal and pelvic spaces.

1)自发性腹下神经重建：犬腹下神经部分切除（2.5 cm） 4年后，刺激腰植神经（LSN）引起输精管、膀胱颈和前列腺收缩。从LSN到靶器官的多个交叉通路也被证明是自发重建的。2)横断的自主神经再植：(1)横断的犬腹下神经再植18个月后：刺激LSN引起输精管、膀胱颈和前列腺收缩。从LSN到靶器官的多个交叉通路被证明是重建的。再附着的重建率高于未再附着的重建率。(2)经截断的骨盆神经远端再植后，刺激其近端引起膀胱收缩。容量充足，残尿少。(3)自体膀胱移植伴盆腔神经再植成功。尿容量充足，残尿少，保留排尿反射。我们的结果表明，截断的骨盆神经在再附着后9个月内重建。3)自主神经移植：在盆腔神经缺损处移植腹下神经或生殖股神经后，刺激盆腔神经引起膀胱收缩。容量充足，残尿少。4)自主神经转移：将腹下神经与盆腔神经吻合后，构建由脊髓经LSN、腹下神经、盆腔神经、盆腔丛至盆腔内靶器官的通路。5)再植部位的神经组织学研究显示自主神经再生。6)神经移植在腹膜后交感神经系统的临床应用。结果很有希望。

1) Spontaneous reconstruction of the hypogastric nerve : Four years after partial removal (2.5 cm) of the canine hypogastric nerve, stimulation of the lumbar splanchnic nerve (LSN) generated contractions of the vas deferens, bladder neck and prostate. The multiple crossed pathways from the LSN to the target organs were also demonstrated to be reconstructed spontaneously.2) Reattachment of the transected autonomic nerves :(1) Eighteen months after reattachment of transected canine hypogastric nerve : stimulation of the LSN elicited contractions of the vas deferens, bladder neck and prostate. The multiple crossed pathways from the LSN to the target organs were demonstrated to be reconstructed. The rate of reconstruction by reattachment was higher than that without reattachment.(2) After reattachment of transected pelvic nerve at its distal end, stimulation of its proximal end generated bladder contraction. The capacity was sufficient and residual urine was little.(3) Auto-transplantation of the bladder accompanied with pelvic nerve reattachment succeeded. The capacity was sufficient, residual urine little, and voiding reflex was preserved. Our results indicated that reconstruction of the transected pelvic nerve occurs within 9 months after reattachment.3) Autonomic nerve graft : After grafting the hypogastric nerve or the genitofemoral nerve into the defect of the pelvic nerve, stimulation of the pelvic nerve elicited bladder contraction. The capacity was sufficient and residual urine was little.4) Autonomic nerve-transfer : After anastomosis of the hypogastric nerve with the pelvic nerve, the pathway from the spinal cord, passing through the LSN, hypogastric nerve, pelvic nerve and pelvic plexus to the intrapelvic target organs were constructed.5) Histological study of the nerve at the site reattached demonstrated regeneration of the autonomic nerve.6) Nerve graft was clinically applied in retroperitoneal sympathetic nervous system. The result was promising.