保留盆腔自主神经在男性腹腔镜直肠癌根治术中的临床效果

摘要

Objective:To investigate the feasibility and treatment effect of total mesorectal excision ( TME) and pelvic auto-nomic nerve preservation ( PANP) for rectal carcinoma in specific stage as well as the impact on postoperative urination function ,erec-tile function and ejaculation function dominated by the pelvic autonomic nerve .Methods:Male patients ( n=117 ) with rectal carcinoma in Wuhan Commercial Employees Hospital from Jan .2012 to Dec.2015 were selected in this retrospective study ,they were divided into laparoscopic group ( laparoscopic TME+PANP) and open group ( open TME+PANP) .Intraoperative and postoperative clinical inde-xes as well as urination function and sexual function within one year after the operation were comparatively analyzed .Results:After the operation for three months,the urine storage,urination,erectile and ejaculation function in the laparoscopic group were better than those in the open group.There was no significant difference in the long-term (1 year after surgery) therapeutic effect between the two groups . Conclusions:For rectal carcinoma below T 3 N2 M0 stage,PANP in laparoscopic radical resection of rectal carcinoma is safe and feasible . It maintains urination function and sexual function of male patients to the greatest extent .%目的:探讨腹腔镜直肠癌根治术中应用全直肠系膜切除术(total mesorectal excision,TME)及保留盆腔自主神经(pelvic autonomic nerve preservation,PANP)对特定分期直肠癌的可行性、治疗效果及对盆腔自主神经所支配的(男性)患者术后排尿、勃起、射精功能的影响.方法:选择2012年1月至2015年12月手术治疗的117例直肠癌男性患者,分为腹腔镜TME+PANP组(腹腔镜组)与开腹TME+PANP组(开腹组),对比分析术中、术后各项临床指标及术后1年内排尿、性功能各项指标.结果:腹腔镜组术后3个月储尿、排尿、勃起、射精功能均优于开腹组;而远期(术后1年)疗效两组差异无统计学意义.结论:对于T3 N2 M0期及以下的直肠癌患者,保留盆腔自主神经的腹腔镜直肠癌根治术安全、可行,最大限度地维持了男性患者的排尿功能及性功能.