盆底自主神经保留在直肠癌腔镜切除手术中的应用价值  

Application Value of Pelvic Autonomic Nerve Preservation in Laparoscopic Resection of Rectal Cancer

作　　者：周廷亮 张跃[1] 蒋笃均[1] 蔡彬 ZHOU Tingliang;ZHANG Yue;JIANG Dujun(Xuzhou Cancer Hospital,Xuzhou,221002)

机构地区：[1]江苏省徐州市肿瘤医院

出　　处：《实用癌症杂志》2019年第12期2031-2034,共4页The Practical Journal of Cancer

摘　　要：目的探讨盆底自主神经保留(pelvic autonomic nervepreservation,PANP)直肠癌腔镜切除手术对男性患者排尿功能、性功能以及术后生活质量的影响。方法选取150例男性直肠癌患者,根据随机数字表法随机分为腹腔镜组(n=75)和开腹组(n=75)。腹腔镜组患者行腹腔镜下PANP直肠癌根治术,开腹组患者行开腹PANP直肠癌根治术,2组均遵循全直肠系膜切除(total mesorectal excision,TME)原则。比较2组围手术期指标、术后排尿功能、性功能以及生活质量评分。结果腹腔镜组手术时间(186.23±26.78)min,显著长于开腹组(P<0.05);腹腔镜组术后排气时间、尿管拔出时间分别为(3.21±1.46)d和(2.63±0.88)d,显著短于开腹组(P<0.05);2组切除淋巴结数和并发症发生率差异无统计学意义(P>0.05)。术后2周,2组排尿量差异无统计学意义(P>0.05);腹腔镜组最大尿流率为(28.97±3.57)ml/s,显著高于开腹组(P<0.05);残余尿量为(14.26±3.55)ml,显著少于开腹组;腹腔镜组排尿功能障碍显著较轻(P<0.05)。术后3个月,腹腔镜组性功能(勃起功能和射精功能)显著优于开腹组(P<0.05)。术后6个月,腹腔镜组生活质量各项评分均显著高于开腹组(P<0.05)。结论直肠癌腔镜下行PANP切除手术虽手术时间较长,但术后排气和尿管拔出时间较短,并可较好保护患者排尿功能和性功能,提高患者术后生活质量。Objective To investigate the effect of pelvic autonomic nerve preservation(PANP)laparoscopic resection of rectal canceron the urinary function,sexual function and postoperative quality of life of male patients.Methods 150 male patients with rectal cancer were selected and divided into the laparoscopic group(n=75)and the open group(n=75)by random number table method.The laparoscopic group were treated with laparoscopic PANP radical resection of rectal cancer while theopen group were treated with open PANP radical resection of rectal cancer.Both groups underwent total mesorectal excision(TME).Theperioperative indexes,postoperative urinary function,sexual function and quality of life scores were compared between the 2 groups.Results The operation time of the laparoscopic group[(186.23±26.78)min]was significantly longer than that of the open group,and the postoperative exhaust time and extubation time[(3.21±1.46)d and(2.63±0.88)d]was significantly shorter than the open group(P<0.05).There was no significant difference in the number of dissected lymph nodes or the incidence of complications between the two groups(P>0.05).2 weeks after operation,there was no significant difference between the two groups in urine volume(P>0.05).The maximum urinary flow rate of the laparoscopic group[(28.97±3.57)ml/s]was significantly higher than that of the open group,and residual urine volume[(14.26±3.55)ml]was significantly less than the open group(P<0.05).The voiding dysfunction was significantly milder in the laparoscopic group(P<0.05).3 months after operation,the sexual function(erectile function and ejaculation function)of the laparoscopic group was significantly bettwer than that of the open group(P<0.05).6 months after operation,the quality of life scores of the laparoscopic group were significantly higher than those of the open group(P<0.05).Conclusion Although the time of laparoscopic PANP resection of rectal cancer is relatively longer,the time of exhaust and urinary catheter removal is shorter.It can better protect pati

关 键 词：盆底自主神经保留 直肠癌 腹腔镜 排尿功能 性功能 

分 类 号：R735.37[医药卫生—肿瘤]