oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences10.21294/1814-4861-2019-18-2-58-64oncotomsk-1015Research ArticleОПЫТ РАБОТЫ ОНКОЛОГИЧЕСКИХ УЧРЕЖДЕНИЙONCOLOGY PRACTICEИспользование интраоперационного нейромониторинга для определения вегетативных нервов малого таза при хирургическом лечении рака прямой кишки: обзор литературы и первичный опыт клиникиIntraoperative neuromonitoring of pelvic autonomic nerves during surgigal treatment of colorectal cancer: a review of the literature and the initial experience of our clinichttps://orcid.org/0000-0002-7134-6821ЦарьковП. В.TsarkovP. V.

Царьков Петр Владимирович,профессор, доктор медицинских наук, заведующий кафедрой хирургии медико-профилактического факультета, директор клиники колопроктологии и малоинвазивной хирургии. SPIN-код: 7570-0664. Researcher ID (WOS): P-4909-2017. Author ID (Scopus): 6602234858.

Petr V. Tsarkov,MD, Professor, Head of Surgery Department. Researcher ID (WOS): P-4909-2017. Author ID (Scopus): 6602234858.

1, Pogodinskaya Street, 119435-Moscow.

tsarkov@kkmx.ruhttps://orcid.org/0000-0001-5522-2549КочетковВ. С.KochetkovV. S.

Кочетков Виктор Сергеевич,врач-колопроктолог клиники колопроктологии и малоинвазивной хирургии. SPIN-код: 5161-4040.

г. Москва, 119435, ул. Погодинская, 1с1.

Viktor S. Kochetkov,MD, Physician.

1, Pogodinskaya Street, 119435-Moscow.

kochetkov@kkmx.ruhttps://orcid.org/0000-0003-0283-2217ЕфетовС. К.EfetovS. K.

Ефетов  Сергей  Константинович, кандидат  медицинских  наук,  доцент  кафедры  хирургии  медико-профилактического  факультета, заведующий отделением колопроктологии. SPIN-код: 7494-3595. Author ID (Scopus): 57190420104.

г. Москва, 119435, ул. Погодинская, 1с1.

Sergey K. Efetov,MD, PhD, Head.

1, Pogodinskaya Street, 119435-Moscow.

efetov@mail.ruhttps://orcid.org/0000-0002-4415-6141КиценкоЮ. Е.KitsenkoYu. E.

Киценко Юрий Евгеньевич,ассистент кафедры хирургии медико-профилактического факультета, врач-колопроктолог отделения колопроктологии. SPIN-код: 4673-1926.

г. Москва, 119435, ул. Погодинская, 1с1.

Yury E. Kitsenko,MD, Physician.

1, Pogodinskaya Street, 119435-Moscow.

kitsenko@kkmx.ruСтамовВ. И.StamovV. I.

Стамов Виталий Иванович,кандидат медицинских наук, заведующий отделением анестезиологии и реанимации. SPIN-код: 5048-2514. Researcher ID (WOS): D-1833-2018. Author ID (Scopus): 23500045400.

г. Москва, 119435, ул. Погодинская, 1с1.

Vitaliy I. Stamov,MD, PhD, Head of Intensive Care Unit. Researcher ID (WOS): D-1833-2018. Author ID (Scopus): 23500045400.

1, Pogodinskaya Street, 119435-Moscow.

stamov@kkmx.ruКлиника колопроктологии и малоинвазивной хирургии УКБ № 2, ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова».РоссияClinic of Coloproctology and Minimally Invasive Surgery, I.M. Sechenov First Moscow State Medical University.Russian Federation2019250420191825864Copyright © Царьков П.В., Кочетков В.С., Ефетов С.К., Киценко Ю.Е., Стамов В.И., 20192019Царьков П.В., Кочетков В.С., Ефетов С.К., Киценко Ю.Е., Стамов В.И.Tsarkov P.V., Kochetkov V.S., Efetov S.K., Kitsenko Y.E., Stamov V.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/1015Введение

Введение. Расстройство мочеполовых функций и анальная инконтиненция – частые осложнения хирургического лечения рака прямой кишки, которые связаны с повреждением вегетативных нервных стволов малого таза. Поиск методов интраоперационной идентификации вегетативных нервных сплетений – одна из задач современной хирургии рака прямой кишки.

Цель исследования – оценить возможности интраоперационного нейромониторинга при хирургическом лечении рака прямой кишки.

Материал и методы

Материал и методы. В 2017 г. на базе клиники проведены 2 операции по поводу рака прямой кишки с интраоперационным нейромониторингом. Во время операций идентифицированы поясничные внутренностные нервы, гипогастральные нервы, нижние гипогастральные сплетения, выполнен запланированный объем оперативного лечения с сохранением элементов вегетативной нервной системы. В послеоперационном периоде проводилась оценка функционального состояния мочеполовой сферы, анальной континенции, пациентам проводились периодические исследования в соответствии с программой мониторинга колоректального рака.

Результаты

Результаты. Удовлетворительные функциональные результаты в позднем послеоперационном периоде и через 12 мес наблюдения позволяют говорить о том, что интраоперационный нейромониторинг при резекциях прямой кишки может быть использован для идентификации и предотвращения повреждения вегетативных нервных сплетений малого таза у пациентов с диагностированным раком прямой кишки.

Заключение

Заключение. В качестве интраоперационного метода определения вегетативных нервных сплетений данный метод в настоящее время сложно рассматривать как основной, но он имеет перспективы с точки зрения изучения физиологии малого таза. При дальнейшем развитии интраоперационного нейромониторинга можно будет получить методику, совершенствующую технические приемы оперативного лечения рака прямой кишки. Необходимо продолжить исследования с использованием интраоперационного нейромониторинга и определить его значение для сохранения мочевой, аноректальной и половой функций.

Introduction

Introduction. Urogenital and anorectal functional disturbances associated with the pelvic autonomic nerve damage are common complications of rectal cancer surgery. the search for methods of intraoperative identification of the autonomic nerve plexus is currently one of the key tasks in modern surgery of rectal cancer. the purpose of our study is to evaluate the role of intraoperative neuromonitoring in rectal cancer surgery.

Material and methods

Material and methods. In 2017 we performed intraoperative neuromonitoring during rectal cancer surgery in two cases. the superior hypogastric plexus and the inferior hypogastric plexus were identified and the pelvic autonomic nerve was preserved in both patients. urogenital and anorectal functional outcomes were assessed in the postoperative period.

Results

Results. Satisfactory functional outcomes in the late postoperative period and at the 12-month follow-up suggest that intraoperative neuromonitoring may be useful in identification and prevention of the pelvic autonomic nerve damage in patients with rectal cancer.

Conclusion

Conclusion. This method would be difficult to use routinely for intraoperative identification of the autonomic nerve plexus but could be especially useful for the study of pelvic physiology. With further development, the method of intraoperative neuromonitoring could help discover a technique that will improve the surgical treatment of rectal cancer. Further research using intraoperative neuromonitoring is needed to more precisely determine its value in the preservation of urinary, anorectal and sexual function.

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The authors declare that there are no conflicts of interest present.