臺灣博碩士論文加值系統

交感神經系統由連結到內臟的運動神經所組成 。從脊髓旁與脊髓前神經節至腸胃道的神經傳導路徑已有完整資料。臨床上， 胸腔與內臟的自主神經切除術分別用於控制多汗症與源自於長期胰臟炎與胰臟癌的腹腔疼痛。但對於脊髓旁與脊髓前神經節之間的連結了解甚少。本實驗把WGA-HRP分別注射到老鼠腹腔神經節(celiac ganglia, CG, N=6)或上腸繫膜神經節(superior mesenteric ganglion, SMG, N=6)來回溯位於脊髓旁神經節（paravertebral ganglia）的神經細胞。三天後， 將包括星狀神經節(stellate ganglion, SG)、脊髓旁神經節鏈(從位於胸腔脊髓第四節的神經節到第十一節，paravertebral chains, T4-T11)、內臟神經節(splanchnic ganglia, SPL)、CG、與SMG等交感神經連結取下，用來進行HRP-TMB反應。在神經追蹤劑注射後，可以染到從SPL到SG的所有交感神經節，雙側之間的細胞數目沒有差異。其分布主要在SG、T11、與SPL，而其神經細胞的平均數（CG, SMG）分別為：SPL (273±19, 336±15)、T11 (258±16, 216±24)、T10 (31.6±3.5, 42.2±6.2)、 T9 (26±1.7, 19.2±3.4)、T8 (11.2±1.2, 11.7±1)、T7 (9.4±1.3, 7.8±1.2)、T6 (5.8±0.8, 4.0±0.6)、T5 (2.4±0.5, 1.3±0.5)、T4 (0.9±0.3, 0.4±0.2)、以及SG (681±33, 582.1±25)。前端交感神經節有眾多神經元投射軸突經過尾端的腹腔神經節與上腸繫膜神經節，而到達腹腔臟器。存在這麼多神經投射路徑的事實，使得在做胸腔與內臟的自主神經切除術時，有必要對其副作用進行深入的評估。另外，從星狀神經節投射到腹腔臟器的神經路徑，可能在緊急狀況裡扮演著調節腹腔與四肢之間血流量的重要角色。

The sympathetic system consists of efferent neurons that innervate the viscera. Pathways issuing from the para- and pre-vertebral ganglia to the gastrointestinal tract have been well established. Clinically, thoracic and splanchnic sympathectomies have been used respectively as a treatment to control the hyperhidrosis and visceral pain that originates from chronic pancreatitis and pancreatic carcinoma. However, little is known on the connection between the paravertebral and prevertebral ganglia. Male Sprague-Dawley rats were injected with the WGA-HRP into the celiac (CG, N=6) or superior mesenteric ganglia (SMG, N=6) to retrogradely trace neurons in the paravertebral ganglia. Three days later, both sides of the sympathetic trunks, including stellate (SG), paravertebral chains (T4-T11), splanchnic (SPL), celiac, and superior mesenteric ganglia, were reserved for the HRP-TMB reaction. After tracer injection, neurons were labeled bilaterally in all of the sympathetic ganglia from the SPL up to the SG and mainly found in the stellate, T11, and splanchnic ganglia. The average numbers of neurons labeled in each sympathetic ganglion after ganglion (CG, SMG) injection were: SPL (273±19, 336±15), T11 (258±16, 216±24), T10 (31.6±3.5, 42.2±6.2), T9 (26±1.7, 19.2±3.4), T8 (11.2±1.2, 11.7±1.0), T7 (9.4±1.3, 7.8±1.2), T6 (5.8±0.8, 4.0±0.6), T5 (2.4±0.5, 1.3±0.5), T4 (0.9±0.3, 0.4±0.2), and SG (681±33, 582±25). The fact that numerous neurons project axons from the rostral sympathetic ganglia, bypass the caudal celiac and superior mesenteric ganglia, and presumably reach the abdominal viscera raises the assessment requirement for the side effects of the thoracic or splanchnic sympathectomy. Furthermore, neurons that project from the stellate ganglion to the abdominal viscera may play a role in shuffling the blood volumes between the abdomen and the limbs in the emergent conditions.

TABLE OF CONTENTS
Page
TABLE OF CONTENTS…………………………………………….. ii
LIST OF FIGURES…………………………………………………...iii
ABSTRACT…………………………………………………………...iv
INTRODUCTION…………………………………………………….1
MATERIALS AND METHODS……………………………………..7
RESULTS…………………………………………………………….10
DISCUSSION………………………………………………………..18
REFERENCE………………………………………………………...24

1.Adar, R., Kurchin, A., Zweig, A., & Mozes, M. (1977). Palmar hyperhidrosis and its surgical treatment: a report of 100 cases. Annals of Surgery, 186:34-41.
2.Armour, J. A., & Ardell, J. L. (1994). Neurocardiology. Oxford University Press, p.219-244.
3.Celler, B.G. & Schramm, L.P. (1981) Pre- and postganglionic sympathetic activity in splanchnic nerves of rats. American Journal of Physiology, (1):55-61.
4.Cheng, P.-M. (2003). Connections of the rat superior cervical ganglion. Thesis, National Chung Cheng University.
5.Chevendra, V. &. Weaver, L. C. (1991). Distribution of splenic, mesenteric and renal neurons in sympathetic ganglia in rats. Journal of the Autonomic Nervous System, 33:47-54.
6.Cinca, J., Evangelista, A., Montoyo, J., Barutell, C.,Figueras, J., Vallle, V., Rius, J., & Soler-Soler, J. (1985). Electrophysiologic effects of unilateral right and left stellate ganglion block on the human heart. American Heart Journal, 109:46-54.
7.Dail, W. G. & Barton S. (1983). Structure and organization of mammalian sympathetic ganglia. In Autonomic Ganglia, (Ed. L. G. Elfvin), John Wiley and Sons Ltd, p.3-25.
8.Dalsgaard, C. J. & Elfvin, L.G. (1982). Structural studies on the connectivity of the inferior mesenteric ganglion of the guinea pig. Journal of the Autonomic Nervous System, 5:265-278.
9.De Cicco, M., Matovic, M., Balestreri, L., Fracasso, A., Norassut, S., & Testa, V. (1997). Single-needle celiac plexus block. Anesthesiology, 87:1301-1308.
10.Drott, C., G.othberg, G. & Claes, G. (1993). Endoscopic procedures of the upper-thoracic sympathetic chain. Archives of Surgery, 128(2):237-241.
11.Dumont P, Denoyer A, & Robin P. (2004). Long-term results of thoracoscopic sympathectomy for hyperhidrosis. The Annals of Thoracic Surgery, 78(5):1801-7.
12.Fujita, Y. (1988). Splanchnic circulation following coeliac plexus block. Acta Anaesthesiologica Scandinavica, 32(4):323-327.
13.Furness, J. B., Koopmans H. S., Woodman, H. L. & Lin, H. C. (2000). Identification of intestinofugal neurons projecting to the celiac and superior mesenteric ganglia in the rat. Autonomic Neuroscience, 83:81-85.
14.Gossot D., Galetta D., Pascal A., Debrosse D., Caliandro R., Girard P., Stern J. B., & Grunenwald D. (2003). Long-term results of endoscopic thoracic sympathetomy for upper limb hyperhidrosis. The Annals of Thoracic Surgery, 75:1075-1079.
15.Hamer, D. W. & Santer, R. M. (1981). Anatomy and blood supply of the celiac-superior mesenteric ganglion complex of the rat. Anatomy and Embryology, 162:353-362.
16.Haugen F. P. (1968). The autonomic nerves system and pain. Anesthesiology, 20:785-792.
17.Hill, C. E., Hendry, I. A. & Sheppard, A. (1987). Use of the fluorescent dye, Fast Blue, to label sympathetic postganglionic neurons supplying mesenteric arteries and enteric neurons of the rat. Journal of the Autonomic Nervous System, 18:73-82.
18.Hudson, L. C. (1989). The location of extrinsic efferent and afferent nerve cell bodies of the normal canine stomach. Journal of the Autonomic Nervous System, 28:1-14.
19.Ischia R., Hobisch A., Bauer R., Weiss U., Gasser R. W., Horninger W., Bartsch G., Jr., Fuchs D., Bartsch G., Winkler H., Klocker H., Fischer-Colbrie R., and Culig Z. (2000). Elevated levels of serum secretoneurin in patients with therapy resistant carcinoma of the prostate. The Journal of Urology: Official Journal of the American Urological Association, 163:1161-1164.
20.Janig, W. & McLachlan, E. M. (1987). Organization of lumbar spinal outflow to distal colon and pelvic organs. Physiological Reviews, 67:1332-1404.
21.Kestenholz, P. B., & Weder, W. (2002). Thoracic sympathectomy. Current Problems in Dermatology, 30:64-76.
22.King, B. F. & Szurszewski, J. H. (1989). Peripheral reflex pathways involving abdominal viscera: Transmission of impulses through prevertebral ganglia. American Journal of Physiology, 256:G581-G588.
23.Kreulen, D.L. & Szurszewski, J.H (1979). Reflex pathways in the abdominal prevertebral ganglia: evidence for a colo-colonic inhibitory reflex. Journal of Physiology (London), 295:21-32.
24.Kruger S., Fronek K. S., Schmelz M., Horbach T., Hohenberger W., & Schick C. H. (2003). Differential effects of surgical sympathetic block at the T2 and T4 level on vasoconstrictor function. Clinical Autonomic Research, 13 (1):179-182.
25.Kuntz. (1938). The structural organization of the celiac ganglia. Journal of Comparative Neurology, 69:1-12.
26.Kuntz, A. & Saccomanno, G., (1944). Reflex inhibition of intestinal motility mediated through decentralized prevertebral ganglia. Journal of Neurophysiology, 7:163-170.
27.Kuo, D.C. & Krauthamer, G. M. (1981). Paravertebral origin of postganglionic sympathetic fibers in the major splanchnic a distal celiac nerves as demonstrated by horseradish peroxidase (HRP) retrograde transport method. Journal of the Autonomic Nervous System, 4:25-32.
28.Langley, N. N. (1986). On the nerve cell connection of the splanchnic nerve fibers. Journal of Physiology, 20:223-246.
29.Lebovits, A. H. & Lefkowitz, M. (1989). Pain management of pancreatic carcinoma: A review. Pain, 36(1):1-11.
30.Leksowski K. (2001). Thoracoscopic splanchnicectomy for control intractable pain due to advanced pancreatic cancer. Sugical Endoscopy: Ultrasound and Interventional Techniques, 15(2):129-131.
31.Lichtman, J. W., Purves D. & Yip, J. W. (1979). On the purpose of selective innervation of guinea- pig superior cervical ganglion cells. Journal of Physiology, 292:69-84.
32.Lin, C. C., Mo, L. R., Lin, Y. W. & Yau, M. P. (1994). Bilateral thoracoscopic lower sympathetic-splanchnicectomy for upper abdominal cancer pain. European Journal of Surgery, 160 (Suppl 572):59-62.
33.Lipsitz, L.A., Pincus, S.M., Morin, R.J., Tong, S., Eberle, L.P., & Gootman, P.M. (1997). Preliminary evidence for the evolution in complexity of heart rate dynamics during autonomic maturation in neonatal swine. Journal of Autonomic Nervous System, 65:1-9.
34.Loewy, A. D. and Spyer, K. M. (1990). Anatomy of the autonomic nervous system: An overview. Central Regulation of Autonomic Functions. Oxford University Press, New York, p.3-16.
35.Lu, K. S., Lever, J. D., Santer, R. M., & Presley, R. (1976). Small granulated cell typed in rat superior cervical and celiac-mesenteric ganglia. Cell Tissue Research, 172:331-343.
36.Lundberg, J. M., Dahlstrom, A., Larsson, I., Petterson, G., Ahlman, H. & Kewenter, J. (1978). Efferent innervation of the small intestine by adrenergic neurons from the cervical sympathetic and stellate ganglion, studied by retrograde transport of peroxidase. Acta Physiologica Scandinavica, 104:33-42.
37.Maharaj, B., Luvuno, F. M., Leary, W. P., & Pudifin, D.J. (1987). The conservative management of amebic liver abscess complicated by thoracic extension. Tropical and Geographical Medicine, 39:299-302.
38.McLachlan, E. M., & Hist, G. D. S. (1984). Some properties of preganglionic neurons in upper thoracic spinal cord of the cat. Journal of Neurophysiology, 43:1251-1265.
39.Messengers, J. P. & Furness, J. B. (1992). Distribution of enteric nerve cells projecting to the celiac ganglion of the guinea-pig. Cell Tissue Reseach, 269:119-132.
40.Messengers, J. P. & Furness, J. B. (1993). Distribution of enteric nerve cells that projecting to the superior and inferior mesenteric ganglia of the guinea- pig. Cell Tissue Reseach Commn, 271:333-339.
41.Moodley J., Singh B., Shaik A. S., Haffejee A., & Rubin J. (1999). Thoracoscopic splanchnicectomy: pilot evaluation of a simple alternative for chronic pancreatic pain control. World Journal of Surgery, 23:688-692.
42.Musch, T.I., Friedman, D.B., Pitetti, K.H., Haidet, G.C., Stray-Gundersen, J., Mitchell, J.H., & Ordway, G. A. (1987). Regional distribution of blood flow of dogs during graded dynamic exercise. Journal of Applied Physiology, 63:2269-77.
43.Noriyuki, O. & Grbhart, G. F. (2001). Characterization of mechanosensitive splanchnic nerve afferent fibers innervating the rat stomach. American Journal of Physiology: Gastrointestinal and Liver Physiology, 281:G1449-G1459.
44.Nyamekye, I.K. (2004). Current therapeutic options for treating primary hyperhidrosis. European Journal of Vascular and Endovascular Surgery, 27(6):571-6.
45.Orteu, C. H., McGregor, J. M., Almeyda, J. R., & Rustin, M. H. (1995). Recurrence of hyperhidrosis after endoscopic transthoracic sympathectomy—case report and review of the literature. Clinical and Experimental Dermatology, 20:230-233.
46.Pan, H.L., Zeisse, Z.B., & Longhurst, J.C. (1996). Role of summation of afferent input in cardiovascular reflexes from splanchnic nerve stimulation. The American Journal of Physiology, 270:H849-H856.
47.Pan, H.L., Zeisse, Z.B., & Pitsillides, K.F., & Longhurst, J.C. (1997). Spatiotemporal aspects of sympathetic C-fiber afferent activity in pressor reflex during abdominal ischemia. The American Journal of Physiology, 272:H1928-H1936.
48.Pardini, B. J., Lund, D. D., & Schmid, P. G. (1989). Orgnization of the sympathetic postganglionic innervation of the rat heart. Journal of Autonomic Nervous System, 28:193-202.
49.Pardini, B. J., Lund, D. D., & Schmid, P. G. (1990). Innervation patterns of the middle cervical stellate ganglion complex in the rat. Neuroscience Letter, 117:300-306.
50.Petras, J. M. & Cummings J. F. (1978). Sympathetic and parasympathetic innervation of the urinary bladder and urethra. Brain Research, 153:363-369.
51.Rykowski, J.J. & Hilgier, M.(2000). Efficacy of neurolytic celiac plexus block in varying location of pancreatic cancer: influence on pain relief. Anesthesiology, 92:347-354.
52.Sato, K., Kang, W. H., Saga, K., & Sato, K. T. (1989). Biology of sweat glands and their disorders. II. Disorders of sweat gland function. Journal of the American Academy of Dermatology, 20:537-563.
53.Simon, E., & Riedel, W. (1975). Diversity of regional sympathetic outflow in integrative cardiovascular control: patterns and mechanisms. Brain Research, 87:323-333.
54.Stebbing, M. J. & Bornstein, J. C. (1993). Electrophysiological analysis of the convergence of peripheral inputs onto neurons of the celiac ganglion in the guinea pig. Journal of the Autonomic Nervous System, 46:93-105.
55.Stone, H. & Chauyin, J. (1990). Pancreatic denervation for pain relief in chronic alcohol associated pancreatitis. British Journal of Surgery, 77:303-305.
56.Strack, A. M., Sawyer, W. B., Marubio, L. M., & Loewy, A. D. (1988). Spinal orgin of sympathetic preganglionic neurons in the rat. Brain Research, 455:187-191.
57.Toshiomi, K., Hiroshi, M., Masayuki, S., Mamoru, Y., Misuyuki, M., & Yoshihiro, M. (1997). Thoracoscopic thoracic splanchnicectomy for chronic pancreatitis with intractable abdominal pain. Surgical Laparoscopy & Endoscopy, 7(3):213-218.
58.Wang, F.-B. (1995). Inventory and distribution of vagal afferent projections in the muscular wall of the rat gastrointestinal tract. Dissertation, Purdue University.
59.Wang, F.-B. & Cheng, P.-M. (2004). Superior cervical ganglion: Inputs and axons of passage. Abstract of Society for Neuroscience, 74.3.
60.Wang, F.B. & Powley, T.L. (2000). Topographic inventories of vagal afferents in gastrointestinal muscle. The Journal of Comparative Neurology, 421(3):302-24.