基于神经层面指引的腹腔镜全直肠系膜切除术  

Nerve plane-oriented laparoscopic total mesorectal excision of rectal cancer

作　　者：杨超[1] 黄朔阳 郑勇斌[1] 童仕伦[1] 何小波[1] 曹峰瑜[1] 杨玉杰 程煌荣 Yang Chao;Huang Shuoyang;Zheng Yongbin;Tong Shilun;He Xiaobo;Cao Fengyu;Yang Yujie;Cheng Huangrong(Department of Gastrointestinal Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院胃肠外科,430060

出　　处：《中华普通外科杂志》2020年第10期757-763,共7页Chinese Journal of General Surgery

基　　金：国家自然科学基金项目(81372553);吴阶平医学基金会临床科研专项资助基金(320.2710.1855)。

摘　　要：目的研究基于神经层面指引的腹腔镜直肠癌根治术(NP0+LTME)对患者术后排尿和性功能的保护效果。方法采用回顾性队列分析2016年1月至2018年12月在武汉大学人民医院接受手术治疗的直肠癌患者,其中NP0+LTME组114例,腹腔镜下TME联合盆自主神经保留术(LTME+PANP)组92例,比较两组患者手术及肿瘤相关指标,并随访患者术后排尿和性功能。结果两组手术时间分别为(150±7)min和(154±7)min,差异有统计学意义(t=3.585,P<0.05);术中出血量分别为(9±3)ml和(15±6)ml,差异有统计学意义(t=7.654,P<0.05)。术后3个月,NPO+LTME组排尿功能障碍率低于LTME+PANP组,差异有统计学意义(Z=2.549,P<0.05),但术后6、12个月时,两组排尿功能障碍率差异无统计学意义(Z=0.814,P>0.05;2=1.275,P>0.05)。术后3、6、12个月时NPO+LTME组的男性勃起功能均优于LTME+PANP组,差异均有统计学意义(2=4.917,P<0.05;Z=4.947,P<0.05;Z=4.081,P<0.05);射精功能障碍率均低于LTME+PANP组,差异均有统计学意义(Z=4.464,P<0.05;Z=4.948,P<0.05=4.434,P<0.05);术后3、6、12个月时,女性性功能均优于LTME+PANP组,差异均有统计学意义(Z=2.532,P<0.05;Z=2.364,P<0.05;Z=2.076,P<0.05)。结论NPO+LTME具有较好的手术安全性,同时对患者性功能和早期排尿功能保护具有一定优势。Objective To explore the protective effect of nerve plane-oriented laparoscopic total mesorectal excision(NPO+LTME)for postoperative urinary and sexual function in patients with rectal cancer.Methods Retrospective analysis was performed on rectal cancer patients who received surgical treatment at Renmin Hospital of Wuhan University from Jan 2016 to Dec 2018,including 114 patients in the NPO+LTME group and 92 patients in the laparoscopic TME combined with pelvic autonomic nerve preservation(LTME+PANP)group.Surgical and tumor-related indicators were recorded and compared between the two groups,and postoperative urination and sexual function were followed up.Results There was no significant difference in baseline indicators between the two groups(P>0.05).The operative time of the two groups was(150±7)min and(154±7)min,respectively(t=3.585,P<0.05).Intraoperative bleeding was(9±3)ml and(15±6)ml(f=7.654,P<0.05),respectively.Three months after surgery,the rate of urinary dysfunction in the NPO+LTME group was lower than that in the LTME+PANP group(Z=2.549,P<0.05),but there was no difference between the two groups 6 and 12 months after surgery(Z=0.814,P>0.05 and Z=1.275,P>0.05).At 3,6 and 12 months after surgery,the erectile function in NPO+LTME group was better than that in LTME+PANP group(Z=4.917,P<0.05;Z=4.947,P<0.05 and Z=4.081,P<0.05);The rate of ejaculation dysfunction was also lower than that of the LTME+PANP group(Z=4.464,P<0.05;Z=4.948,P<0.05 and Z=4.434,P<0.05);In addition,postoperative female sexual function was superior to LTME+PANP group(Z=2.532,P<0.05;Z=2.364,P<0.05;Z=2.076,P<0.05).Conclusion NPO+LTME has good surgical safety and also has certain advantages for patient sexual function and early urinary function protection.

关 键 词：直肠肿瘤 排尿障碍 性功能障碍 生理性 神经层面指引 盆自主神经保护 

分 类 号：R735.37[医药卫生—肿瘤]