腹腔镜直肠癌D3淋巴结清扫联合盆底自主神经保留术的疗效及安全性  

Evaluation of efficacy and safety of laparoscopic D3 radical correction with pelvic autonomic nerve preservation for rectal cancer

作　　者：李霆[1] 孟翔凌[1] 张震[1] 

机构地区：[1]安徽医科大学第一附属医院普外科,合肥230022

出　　处：《中华实验外科杂志》2015年第4期721-723,共3页Chinese Journal of Experimental Surgery

基　　金：安徽省高校自然科学重点研究项目（KJ2009A033）;2014年安徽省高校优秀青年人才支持计划项目

摘　　要：目的 探讨腹腔镜直肠癌D3淋巴结清扫联合盆底自主神经保留术的疗效及安全性.方法 分析我院2010年以来行直肠癌D3淋巴结清扫联合盆底自主神经保留术的211例患者的临床资料,其中腹腔镜组131例和开腹组80例,并对两组的统计结果进行比较.结果 所有患者均顺利完成手术,腹腔镜组手术时间为（3.33±0.72）h,术后1～4d下床活动,术后平均排气时间为（3.48 ±0.82）d,术后病理报告切除淋巴结数（14.94±3.41）枚/例,无手术死亡病例,术后并发症发生率为12.2％（16/131）,其中切口感染9例,肺部感染2例,吻合口瘘1例,吻合口出血4例.腹腔镜组与开腹组比较,两组淋巴结清扫数目（P＞0.05）和术后并发症（P＞0.05）的差异无统计学意义,腹腔镜组术后排气时间（P＜0.01）和住院时间（P＜0.05）低于开腹组,开腹组手术时间（P＜0.01）低于腹腔镜组,两者差异有统计学意义（P＜0.05）.腹腔镜组术后性功能和排尿功能障碍与开腹组比较,差异无统计学意义（P＞0.05）.结论 腹腔镜下直肠癌D3淋巴结清扫联合盆底自主神经保留手术是安全可行的,且患者术后恢复快,具有明显的微创优势,同时提高了患者术后的生存质量.Objective To investigate the safety and efficacy of laparoscopic D3 radical correction with pelvic autonomic nerve preservation for rectal cancer.Methods The clinical deta of 211 patients with rectal cancer underwent D3 radical correction with pelvic autonomic nerve preservation in our hospital from 2010 to 2014 were retrospectively analyzed,they were divided into two groups （laparoscopic group,n =131 ; open group,n =80）,the statistical results of the two groups were compared.Results All the operated patients was successful,211 cases were successfully completed surgery.The laparoscopic group mean operative time was （3.33 ± 0.72） h,ambulation began within 1-4 days postoperatively,the average time for passage of flatus was （3.48 ±0.82） d,the median number of total lymph nodes removed was 14.94 ± 3.41.The postoperative complications were observed in 16 of 131 cases （12.2%） including incision infection in 9 cases,Pulmonary infection in 2 cases,anastomotic fistula in 1 cases,anastomotic bleeding in 4 cases,no anastomotic fistula occurred.No significant difference in the number of total lymph nodes removed （P 〉 0.05） and the postoperative complications （P 〉 0.05） was observed between the two groups.Bowel flatus passed and hospital stay （P 〈 0.05） earlier （P 〈 0.01） in laparoscopic than that in open group.Operative time shorter （P 〈 0.01） in open than that in laparoscopic group.no significant difference in urinary dysfunction and sexual dysfunction after operation was observed between the two groups.Conclusion Laparoscopic D3 radical correction with pelvic autonomic nerve preservation for rectal cancer is feasible and safe,quick postoperative recovery,has the obvious advantage of minimally invasive,and the life quality of patients is higher.

关 键 词：直肠癌 腹腔镜 D3根治 盆腔自主神经 

分 类 号：R735.37[医药卫生—肿瘤]