196例腹腔镜直肠癌根治术精准切除及保留盆腔神经的治疗体会  

Precise excision and protection of pelvic nerve in 196 cases of laparoscopic radical resection of rectal neoplasms

作　　者：黄新[1] 申亚伟[1] 郑晨[1] 马小安[1] 唐毅[1] 

机构地区：[1]西安市中心医院普外一科,陕西西安710003

出　　处：《现代肿瘤医学》2016年第17期2747-2750,共4页Journal of Modern Oncology

基　　金：陕西省社会发展科技攻关项目(编号:2015SF068)

摘　　要：目的：总结腹腔镜直肠癌根治术的应用体会。方法：回顾性分析196例腹腔镜直肠癌根治术患者的临床资料。结果：196例患者术后均于7~35天内出院,发生腹腔内出血3例,2例经保守治疗好转,1例经再次手术止血;5例出现吻合口瘘,均给予保守治疗后好转。4例1年后出现肝脏转移和吻合口转移,16例（8%）出现早期（14天内）II级排尿功能障碍,7例（4%）出现Ⅲ级排尿功能障碍,11例（6%）出现术后3个月II级排尿功能障碍,8例（4%）出现术后Ⅲ级排尿功能障碍。102例男性患者,随访患者性生活情况,76例获得随访,出现9例II级（12%）和5例Ⅲ级（6%）勃起功能障碍。所有患者均获3~5年随访,满意率为92%。其中163例术后行化疗,14例行术后放疗,23例术后1~2年内死亡。总的3年存活率为78%,5年存活率为52%。I期患者3年存活率为98%,5年为97%;II期患者3年存活率为83%,5年为79%;Ⅲ期患者3年存活率为52%,5年为49%;VI期患者3年存活率为39%,5年为30%,大致与国内大样本统计相同。结论：腹腔镜直肠癌根治术是安全可行的,术中能够精准切除直肠系膜及保护盆腔神经。Objective：To summarize the experience of laparoscopic rectal cancer resection.Methods：The clinical data of 196 patients was reviewed retrospectively after laparoscopic rectal cancer radical resection.Results：All 196 patients after laparoscopic rectal cancer radical resection left hospital in 7 ~ 35 days.Abdominal bleeding occurred in3 cases,and 2 cases were improved after conservative treatment.5 cases of anastomotic fistula were improved after conservative treatment.Liver metastasis and anastomotic metastasis occurred in 4 cases after 1 year,16 cases（ 8%）with early（ during 14 days） II level voiding dysfunction,7 cases（ 4%） with Ⅲ level voiding dysfunction,11 cases（ 6%） with II level voiding dysfunction after three months,8 cases（ 4%） with Ⅲ level postoperative voiding dysfunction.In 102 male patients,76 cases were followed-up,with erectile dysfunction in 9 cases（ 12%） for Ⅱ level and 5cases（ 6%） for Ⅲ level.All patients were followed-up for 3 ~ 5 years,and satisfaction rate was 92%,of which 163 cases were performed postoperative chemotherapy treatment,14 cases with postoperative radiotherapy.23 cases died in2 years.3-year survival rate was 78%.5-year survival rate was 52%.In I period cases,the 3-year survival rate was 98% and 5-years survival rate was 97%.In II period cases,the 3-year survival rate was 83%.5-years survival rate was 79%.In Ⅲ period cases,the 3-year survival rate was 52% and 5-year survival rate was 49%.In VI period cases,the 3-year survival rate was 39% and 5-year survival rate was 30%.Conclusion：Laparoscopic resection of rectal cancer can accurately excise mesorectum and protect pelvic nerve,reduce tumor recurrence and metastasis,reduce urination and sexual disorders and other complications.

关 键 词：腹腔镜 直肠癌 精准切除 盆腔神经 

分 类 号：R735.37[医药卫生—肿瘤]