以盆腔自主神经和固有筋膜为解剖标志的保留盆腔自主神经TME术对比研究  

Comparative study of pelvic autonomic nerve TME with pelvic autonomic nerve and intrinsic fascia as anatomical markers

作　　者：李甫根 罗文君[1] 钱川[1] 孙萌[1] 许政文 Li Fugen;Luo Wenjun;Qian Chuan;Sun Meng;Xu Zhengwen(Department of Gastrointestinal Surgery,Suining City Central Hospital,Suining Sichuan Province 629000,China)

机构地区：[1]遂宁市中心医院胃肠外科,四川遂宁629000

出　　处：《中华普外科手术学杂志（电子版）》2022年第6期676-679,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：四川省卫生事宜技术推广立项项目(19SYJS32);四川医学科研课题(S19015)。

摘　　要：目的:探究以盆腔自主神经和固有筋膜为解剖标志的保留盆腔自主神经全直肠系膜切除(TME)术在中低位直肠癌中的应用效果。方法:前瞻性选取2018年4月至2020年12月行TME+保留盆腔自主神经(PANP)术的中低位直肠癌男性患者98例,按照随机数字表法分为自主神经组和固有筋膜组,每组49例。自主神经组术中操作以自主神经层面为解剖学标志,固有筋膜组以固有筋膜为解剖学标志。采用软件SPSS 19.0进行统计学分析。围手术期各项指标等计量资料以(x±s)表示,独立样本t检验分析;术后并发症等计数资料采用χ^(2)检验;排尿功能分级、性功能分级等等级计数资料采用非参数秩和检验分析。以P<0.05表示差异有统计学意义。结果:自主神经组患者术后首次通气时间短于固有筋膜组(P<0.05);自主神经组患者排尿功能和性勃起功能优于固有筋膜组(P<0.05)。自主神经组总并发症发生率为10.2%,低于固有筋膜组的16.3%,但组间差异无统计学意义(P>0.05)。结论:对中低位直肠癌男性患者行TME术时以自主神经层面为解剖标志,可更大程度保留盆腔自主神经,减少患者排尿功能和性功能损伤,具有一定应用价值。Objective To explore the effect of pelvic autonomic nerve sparing total inesoreclal resection(TME)with pelvic autonomic nerve ami intrinsic fascia as anatomical markers in middle and low rectal cancer.Methods A total of 98 male patients with moderate anil low rectal cancer who underwent TME+pelvic autonomic nerve preservation(PANP)from April 2018 to December 2020 were prospectively selected and randomly divided into the autonomic nerve group and the inherent fascia group according to the numerical method,with 49 cases in each group.The intraoperative operation of the autonomic nerve group was marked by the autonomic nerve layer,and that of the intrinsic fascia group was marked by the intrinsic fascia.SPSS19.0 was used for statistical analysis.Perioperative indicators and other measurement data were represented by(x±s)and analyzed by independent t test;χ^(2)test was used for counting data of postoperative complications.Nonpararnelric rank sum test was used to analyze the count data of voiding function and sexual function.P<0.05 indicated that the difference was statistically significant.Results The first postoperative ventilation time of the autonomic nerve group was shorter than that of the intrinsic fascia group(P<0.05).Urinary function and erectile function in the autonomic nerve group were belter than those in the intrinsic fascia group(P<0.05).The incidence of total complications in the autonomic nerve group was 10.2%.which was lower than that in the intrinsic fascia group(16.3%),but the difference between groups was not statistically significant(P>0.05).Conclusion When TME is performed on male patients vwitli middle and low rectal cancer,the level of autonomic nerve is used as an unatomical marker,which ran preserve the pelvic autonomic nerve to a greater extent and reduce the urination function and sexual function injury of patients,which has certain application value.

关 键 词：直肠肿瘤 腹腔镜 全直肠系膜切除 保留盆腔自主神经 

分 类 号：R735.37[医药卫生—肿瘤]