Various types of nerve-sparing laparoscopic radical hysterectomies and their effects to bladder functions.

Abstract

Study Object: A detail anatomical structure of pelvic nerve networks, and their functions are still unsolved. The object of this study is to reveal complete anatomical structures of the pelvic nerve networks (hypogastric nerve, pelvic splanchnic nerves (S2-4), pelvic nerve plexus, and it's vesical branches), and also to assess the correlation between the bladder function and the status of the sparing pelvic nerve networks after the laparoscopic radical hysterectomy. Design and setting: We dissected and exposed complete anatomical structures of the pelvic nerve networks in fresh cadavers, and through this cadaveric study, we categorized laparoscopic radical hysterectomies into three groups (group A:complete preservation, group B:incomplete preservation group C: complete sacrifice) based on the status of the sparing pelvic nerve system Patient: Total 42 cases (group A:23 cases, group B:8 cases, group C:11 cases) Measurements and main results: Bladder functions of each groups are evaluated respectively by the Uro-dynamic study. The recovery rate of the sensory nerve function is 100%(23/23) in Group A, 75%(6/8) in Group B, and 0%(0/11) in Group C respectively. The recovery rate of the motor nerve function is 26%(6/23) in group A, 0%(0/8) in Group B, and 0%(0/11) in Group C. Regarding the sensory function, there is no statistically difference between group A and B, however, group C is statistically lower than these two groups. Regarding the motor function, group A is statistically higher than group B and C. And there is no statistically difference between group B and C. Trough our data, we revealed that the sensory nerve is predominantly distributed at the lower (dorsal) half of the pelvic nerve networks, in contrast, the motor nerve is predominantly distributed at the upper (ventral) half. Conclusion: Depends on the risk of the cervical cancer, the bladder function after the laparoscopic radical hysterectomy can be controlled flexibly. Key Words: total laparoscopic nerve sparing radical hysterectomy, afferent and efferent nerve functions of bladder, anatomy of pelvic nerve networks 腹腔鏡下神経温存広汎子宮全摘術における 骨盤神経ネットワークの温存レベルと膀胱機能の相関関係について 倉敷成人病センター 婦人科 金尾祐之、安藤正明、高野みづき、黒土升蔵、海老沢桂子、 梅村康太、由井瞳子、藤原和子、羽田智則、太田啓明