Intraoperative Neurophysiologic Testing of the Perigastric Vagus Nerve Branches to Evaluate Viability and Signals along Nerve Pathways during Gastrectomy

공성호; 김성민; 김동건; 박기홍; 서윤석; 김태한; Il Jung Kim; Jeonghwa Seo; Young Jin Lim; Hyuk-Joon Lee; Han-Kwang Yang

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자료유형: 학술저널

저자정보: 공성호 김성민 김동건 박기홍 서윤석 김태한 Il Jung Kim Jeonghwa Seo Young Jin Lim Hyuk-Joon Lee Han-Kwang Yang

저널정보: 대한위암학회 Journal of Gastric Cancer Journal of Gastric Cancer 제19권 제1호

발행연도: 2019.1

수록면: 49 - 61 (13page)

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Purpose: The perigastric vagus nerve may play an important role in preserving function after gastrectomy, and intraoperative neurophysiologic tests might represent a feasible method of evaluating the vagus nerve. The purpose of this study is to assess the feasibility of neurophysiologic evaluations of the function and viability of perigastric vagus nerve branches during gastrectomy. Materials and Methods: Thirteen patients (1 open total gastrectomy, 1 laparoscopic total gastrectomy, and 11 laparoscopic distal gastrectomy) were prospectively enrolled. The hepatic and celiac branches of the vagus nerve were exposed, and grabbing type stimulation electrodes were applied as follows: 10–30 mA intensity, 4 trains, 1,000 μs/train, and 5× frequency. Visible myocontractile movement and electrical signals were monitored via needle probes before and after gastrectomy. Gastrointestinal symptoms were evaluated preoperatively and postoperatively at 3 weeks and 3 months, respectively. Results: Responses were observed after stimulating the celiac branch in 10, 9, 10, and 6 patients in the antrum, pylorus, duodenum, and proximal jejunum, respectively. Ten patients responded to hepatic branch stimulation at the duodenum. After vagus-preserving distal gastrectomy, 2 patients lost responses to the celiac branch at the duodenum and jejunum (1 each), and 1 patient lost response to the hepatic branch at the duodenum. Significant procedure-related complications and meaningful postoperative diarrhea were not observed. Conclusions: Intraoperative neurophysiologic testing seems to be a feasible methodology for monitoring the perigastric vagus nerves. Innervation of the duodenum via the celiac branch and postoperative preservation of the function of the vagus nerves were confirmed in most patients.

참고문헌 (29)

참고문헌 신청

Bolton JS / 2011 / Postgastrectomy syndromes / Surg Clin North Am 91:1105~1122

Nunobe S / 2007 / Laparoscopy-assisted pylorus-preserving gastrectomy: preservation of vagus nerve and infrapyloric blood flow induces less stasis / World J Surg 31:2335~2340

Suh YS / 2014 / Laparoscopy-assisted pylorus-preserving gastrectomy is better than laparoscopy-assisted distal gastrectomy for middle-third early gastric cancer / Ann Surg 259:485~493

김윤경 / 2014 / Effects of Screening on Gastric Cancer Management: Comparative Analysis of the Results in 2006 and in 2011 / Journal of Gastric Cancer 14(2):129~134

Berthoud HR / 1991 / Topography of efferent vagal innervation of the rat gastrointestinal tract / Am J Physiol 260:R200~R207

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Seong-Ho Kong

소속기관 Department of Surgery Seoul National University Hospital and Seoul National University College of Medicine Cancer Research Institute 101 Daehak-ro Jongno-gu Seoul 03080 Korea