保留盆腔自主神经的腹腔镜全直肠系膜切除术在男性直肠癌患者中的应用  

Laparoscopic total mesorectal excision with pelvic autonomic nerve preservation in male patients with rectal cancer

作　　者：赵强[1] 冯树森[1] 张东成[1] 郭奇 谭望 周述芝[2] Zhao Qiang;Feng Shusen;Zhang Dongcheng;Guo Qi;Tan Wang;Zhou Shuzhi(Department of Gastrointestinal and Breast Surgery;Department of Anesthesiology,Ya’an People’s Hospital,Sichuan 625000,China)

机构地区：[1]雅安市人民医院胃肠甲乳外科,四川雅安625000 [2]雅安市人民医院麻醉科,四川雅安625000

出　　处：《中华普外科手术学杂志（电子版）》2021年第5期539-541,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：四川省医学会科研项目(S18029);四川省卫生适宜技术推广立项项目(19SYJS21)。

摘　　要：目的探讨腹腔镜全直肠系膜切除术(TME)中保留盆腔自主神经(PANP)对男性直肠癌患者排尿功能、性功能的影响及其应用效果。方法回顾性选取2016年8月至2019年10月153例行TME+PANP的男性直肠癌患者,根据手术方式分为开腹组82例和腹腔镜组71例。观察两组患者术后排尿功能、性功能障碍率及术后1年局部复发情况,评价其疗效。采用统计软件SPSS 21.0进行数据分析处理,排尿功能计量资料用(±s)表示,采用独立样本t检验;性功能及复发率等计数资料采用χ^(2)检验,排尿功能采用秩和检验;P<0.05表示差异有统计学意义。结果术后3个月,腹腔镜组膀胱最大容量、最大尿流量、残尿量及排尿功能障碍率优于开腹组(P<0.05);勃起功能障碍率和射精功能障碍率低于开腹组(P<0.05)。术后1年两组局部复发率(2.8%vs.6.1%)组间差异无统计学意义(χ^(2)=0.938,P=0.333)。结论腹腔镜全直肠系膜切除术中保留盆腔自主神经能够有效改善男性患者术后排尿功能、性功能障碍,可在临床推广应用。Objective To investigate the effect of pelvic autonomic nerve preservation(PANP)in laparoscopic total mesorectal resection(TME)in terms of urinary function and sexual function of male patients with rectal cancer.Methods Clinical data of 153 male patients with rectal cancer treated with TME+PANP from August 2016 to October 2019 were analyzed retrospectively.According to the surgical methods,82 patients were divided into the open group and 71 cases into the laparoscopic group.The postoperative urination function,sexual function,dysfunction rate and local recurrence in both groups were observed,and the efficacy was evaluated.Statistical analysis were performed by using SPSS 21.0 software.The measurement data of urination function were expressed as,and were examined by using independent t test.Count data such as sexual function and recurrence rate were analyzed by usingχ^(2) test,and the urination function was analyzed by using rank sum test.A P value of<0.05 was considered as statistically significant difference.Results Three months after the operation,the maximum bladder volume,maximum urine flow,residual urine volume and the rate of urinary dysfunction in the laparoscopic group were much better than those in the open group respectively(P<0.05);The rates of erectile dysfunction and ejaculation dysfunction were much lower than those of the open group respectively(P<0.05).One year after surgery,there was no significant difference between the two groups in local recurrence rate of(2.8%vs.6.1%,P>0.05).Conclusion Pelvic autonomic nerve preservation during laparoscopic total mesorectal resection could effectively improve postoperative urination function and sexual dysfunction of male patients,which would be popular in clinical application.

关 键 词：直肠肿瘤 腹腔镜 全直肠系膜切除术 保留盆腔自主神经 疗效比较研究 

分 类 号：R73[医药卫生—肿瘤]