陰部神経機能からみた直腸癌低位前方切除術後ｓｏｉｌｉｎｇの検討

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  • Physiological Studies on the Pudendal Nerve Function in Patients after Low Anterior Resection for Rectal Cancer

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Aim: To clarify the significance of the roles of the pudendal motor and sensory nerves contribute to involun- tary defecation (soiling) in patients following low anterior resection (LAR) for rectal cancer, we studied the motor latency and sensory function of the pudendal nerves. Materials: Subjects were 28 patients 19 men and 9 women aged 47 to 77 years (mean: 65.4 years) divided into groups A [n=14; LAR with soiling] and B [n=15; LAR without soiling], compared to group C [n=29; control subjects, 19 men and 10 women aged 40 to 66 years (mean: age of 56.5 years)]. Methods: 1) Pudendal nerve motor latency was studied by stimu- lation of nerve roots S2-4 by magnetic stimulation (SMS) to determine the time interval between magnetic stimulation and the first muscle contraction of the external anal sphincter. The pudendal nerve terminal mo- tor latency of the right, left, and posterior side of the anal canal were determined. 2) Anal mucosal electric sen- sitivity was measured using an anal mucosal electric sensitivity test (AMES); The anal canal length was di- vided into 3 zones: lower [portion below 1cm from the dentate line (DL)], middle (DL), and upper zone of the anal canal (portion above 1cm from the DL). A small electric current from a constant current genera- tor was passed between the electrodes until the patient felt a sensation often described as tingling or pulsing. Results: 1) SMS: The conduction delay in group A was significantly longer than in groups B (p<0.01) and C (p<0.01). The conduction delay in group B was significantly longer than that in group C (p<0.01). The conduction delay of SMS in patients with soiling was the longest. 2) AMES: In group C, recording at the mid- dle zone showed the best results. Patients in group A showed the worst results in anal mucosal sensation. Sen- sation in group A was significantly duller than in group B at the upper (p<0.05) and middle (p<0.05) zones. Conclusion: These findings suggest that involuntary defecation (soiling) after LAR may be due to the dam- age to both the pudendal motor nerve and sensory nerve.

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