腹腔镜下直肠癌系膜全切除和盆腔自主神经的关系  

Relationship between excision of laparoscopic total colorectal cancer mesangial and pelvic autonomic nerve

作　　者：牛坚[1] 王月[1] 刘斌[1] 

机构地区：[1]徐州医学院附属医院普外科,徐州221002

出　　处：《安徽医科大学学报》2016年第12期1832-1835,共4页Acta Universitatis Medicinalis Anhui

基　　金：江苏省333人才项目(编号:Ⅲ-2290)

摘　　要：目的通过手术录像研究直肠系膜、Denonvilliers筋膜、直肠侧韧带、直肠系膜周围间隙与盆腔自主神经的解剖特点,进一步了解全直肠系膜切除(TME)以盆腔自主神经为解剖标志的解剖根据。方法回顾性分析腹腔镜男性中低位直肠癌手术录像257例,总结以盆腔自主神经为解剖标志行直肠系膜全切除的经验,并对比认识该解剖观点前后(2011年前组126例,2011年后组131例)的手术相关指标以及对患者术后泌尿和性功能的影响。结果认识以盆腔自主神经为解剖标志观点的2011年后组患者在术中出血量较2011年前组明显下降,手术质量明显提高,淋巴结清扫个数高于2011年前组,术后勃起功能障碍率低于2011年前组,尿潴留率低于2011年前组,差异有统计学意义(P<0.05)。结论以盆腔自主神经为解剖标志的直肠系膜全切除的解剖观点有助于腹腔镜下直肠前方系膜的完整切除和淋巴结清除率,减少术中出血,减轻对泌尿和性功能的损害。Objective To study the anatomy of mesorectum,Denonvilliers fascia,lateral ligament of the rectum and pelvic autonomic nerve by the operation video. To futher understand the view of total mesorectum excision（ TME） guided by pelvic autonomic nerve. Methods Videos of lapamscopic TME for low rectal cancer from 257 cases were retrospectively studied. The experience of TME guided by pelvic autonomic nerve was summarized and postoperative urinary and sexual function of patients were compared between before the year 2011 group and after the year 2011 group. Results Blood loss in operation of after the year 2011 group was significantly lower than before the year 2011 group. The operation quality of after the year 2011 group was higher than before the year 2011 group. The number of lymph node cleaning of after the year 2011 group was higher than before the year 2011 group. The postoperative erectile dysfunction rate of after the year 2011 group was less than before the year 2011 group. Urinary retention rate of after the year 2011 group was less than before the year 2011 group,the difference between the two groups was statistically significant（ P〈0. 05）. Conclusion The views of TME guided by pelvic autonomic nerve are helpful for complete resection and lymph node clearance with laparoscopic rectal mesorectal,reducing hemorrhage and the damage to the urinary and sexual function.

关 键 词：中低位直肠癌 腹腔镜 直肠系膜全切除 盆腔自主神经 

分 类 号：R735.37[医药卫生—肿瘤]