开腹与腹腔镜下保留盆腔自主神经根治术治疗男性低位直肠癌的临床研究  

Effect of open and laparoscopic radical resection with pelvic autonomic nerve preservation for the treatment of low rectal cancer in men

作　　者：闫序波[1] 郭旭[1] 徐孟[1] 王剑峰[1] Yan Xubo;Guo Xu;Xu Meng;Wang Jianfeng.(Department of Anoreetal Surgery, Dalian Central Hospital, Dalian, Liaoning, 116033, China)

机构地区：[1]大连市中心医院肛肠科,辽宁大连116033

出　　处：《结直肠肛门外科》2018年第3期240-244,共5页Journal of Colorectal & Anal Surgery

基　　金：辽宁市科技计划项目(项目编号:2014041013)

摘　　要：目的探讨开腹与腹腔镜下保留盆腔自主神经根治术治疗男性低位直肠癌的效果。方法纳入80例男性低位直肠癌患者作为研究对象,其中以2012年4月至2013年4月40例接受开腹保留盆腔自主神经根治术(O-PANP)的患者为对照组,2013年5月至2014年5月40例接受L-PANP的患者为观察组。比较两组手术基本情况,术后性功能和排尿功能恢复情况及术后3年生存情况。结果观察组术中出血量、术后肛门首次排气时间、进流质饮食时间、首次下床活动时间及住院时间均少于对照组(均P<0.05),两组手术时间和淋巴结清扫数目差异均无统计学意义(均P>0.05)。两组3年总生存率差异无统计学意义(P>0.05),观察组3年无事件生存率高于对照组(P<0.05)。术后半年,观察组勃起、射精功能优于对照组,差异均有统计学意义(均P<0.05);术后1年,观察组勃起功能优于对照组(P<0.05)。术后半年,观察组排尿功能优于对照组(P<0.05);术后1年和术后3年,两组排尿功能差异均无统计学意义(均P>0.05)。结论 L-PANP用于男性低位直肠癌患者较O-PANP更有利于术后康复以及术后性功能和排尿功能的早期恢复,提升术后3年无事件生存率。Objective To investigate the effect of open and laparoscopic radical resection with pelvic autonomic nerve preservation for the treatment of low rectal cancer in men. Methods 80 men with low rectal cancer were included in this study. 40 patients who received open radical resection with pelvic autonomic nerve preservation（O-PANP） from April 2012 to April 2013 were the control group, and 40 patients who received laparoscopic radical resection with pelvic autonomic nerve preservation（L-PANP） from May 2013 to May 2014 were the treatment group. The indices related to surgery, postoperative sexual function, recovery of voiding function and 3-year survival were compared between the two groups. Results The amount of bleeding, time to first anus exhaust after operation,time to fluid intake, time to first off-bed activity, and duration of hospitalization were significantly less in the treatment group than in the control group（P〈0.05）. There was no significant difference between the two groups in duration of operation and the number of lymph node dissection（P〈0.05）. There was no significant difference in 3-year survival rate between the two groups（P〈0.05）. The3-year event-free survival was higher in the treatment group than that in the control group（P〈0.05）. After half a year, the erectile and ejaculatory function were better in the treatment group than in control group（P〈0.05）. After 1 year, erectile function was better in the treatment group than in the control group（P〈0.05）. After half a year, the voiding function was better in the treatment group than in the control group（P〈0.05）. At 1 year and 3 years after the operation, there was no significant difference between the two groups in voiding function（P〈0.05）. Conclusion In men with low rectal cancer, compared with O-PANP, L-PANP is better in postoperative recovery, as well as early recovery of postoperative sexual function and voiding function. It also increases 3-year eventfree survival.

关 键 词：低位直肠癌 开腹保留盆腔自主神经根治术 腹腔镜保留盆腔自主神经根治术 疗效 

分 类 号：R735.3[医药卫生—肿瘤]