목적: Although nerve-sparing surgery has been introduced for female patients with the pelvic tumors, its efficacy is still controversial because of no consensus of the surgical technique and a lack of the physiologic understanding of the pelvic autonomic nerves. Thus, we developed a female animal model for anatomical and functional assessment of the pelvic autonomic nerves in women.
방법: We used female domestic swine, weighing 25 to 30 kg. All procedures were performed under sterile conditions, and anesthetic procedure was induced with ketamine and maintained with enflurane inhalation through intubation. We sacrificed three swine for the anatomical assessment, and eight swine for the functional assessment of the pelvic autonomic nerves. Moreover, we developed a new stimulation system using a bipolar instrument and peripheral nerve stimulator, and made a new monitoring system for evaluating contraction of bladder, vagina and rectum.
결과: Like human, we found bilateral sympathetic trunk and ganglions run beside aorta and inferior vena cava, and thin fibers from sympathetic ganglions joins together to become the superior hypogastric nerve on the aortic bifurcation, which runs bilaterally as the inferior hypogastric nerves. Moreover, we found parasympathetic nerves from S2-S4, which join together with inferior hypogastric nerves and form the pelvic plexus. Then, we found the rectal, vesical and uterine branches of the pelvic plexus. For the functional assessment, we simulated the pelvic parasympathetic nerves, and then found regular contraction in bladder and rectum. On the other hand, sympathetic nerve stimulation decreased the contraction. However, vaginal contraction was different. These results were similar to those from five patients with cervical cancer whose functions of the pelvic autonomic nerves were evaluated during surgery.
결론: The female swine model may be adequate for the anatomical and functional assessment of the pelvic autonomic nerves in women.