低位直肠癌全直肠系膜切除手术中保留盆腔自主神经的临床价值

摘要

目的 探讨低位直肠癌全直肠系膜切除手术中保留盆腔自主神经的临床价值.方法 选择低位直肠癌患者110例,根据随机抽签原则分为观察组与对照组,各55例.观察组给予腹腔镜下保留盆腔自主神经的直肠癌根治术,对照组给予腹腔镜下直肠癌根治术.比较2组术中及术后情况.结果 所有患者都完成手术,无中转开腹情况.2组的手术时间、术中出血量对比无明显差异(P＞0.05);观察组术后肠鸣音恢复时间、排气与排便时间明显少于对照组(P＜0.05).观察组术后14 d的切口感染、吻合口漏、肺部感染、腹腔脓肿、吻合口出血等并发症总发生率为5.5%,对照组为16.4%,观察组术后并发症发生情况明显少于对照组(P＜0.05).术后3个月进行评定,观察组排尿功能Ⅰ级46例,Ⅱ级6例,Ⅲ级3例,Ⅳ级0例;对照组排尿功能Ⅰ级32例,Ⅱ级11例,Ⅲ级10例,Ⅳ级2例,观察组明显优于对照组(P＜0.05).结论 低位直肠癌全直肠系膜切除手术中保留盆腔自主神经具有很好的应用可行性,能减少术后并发症的发生,促进患者康复,有利于促进泌尿系统功能的恢复.%Objective To investigate the efficacy of pelvic autonomic nerve preservation in the total mesorectal excision for low rectal cancer.Methods 110 low rectal cancer patients were equally divided into the observation group and the control group,each with 55 patients,the observation group was given laparoscopic pelvic autonomic nerve preservation in the total mesorectal excision,the control group was given laparoscopic radical resection.Results All patients were completed surgery and were without conversion.The operative time,the bleeding volume of the 2 groups had no significant difference(P＞0.05),the postoperative bowel sound recovery,flatus and defecation times in the observation group were significantly less than the control group(P＜0.05).The postoperative 14 d of incision infection,anastomotic leakage,pulmonary infection,abdominal abscess,anastomotic bleeding and complication rate in the observation group was 5.5%,so that was 16.4% in the control group,the observation group was significantly less than the control group(P＜0.05).The postoperative 3 months of urinary function in the observation group of 46 patients were grade Ⅰ,6 patients were grade Ⅱ,3 patients were grade Ⅲ;32 patients were grade Ⅰ in the control group,11 patients were grade Ⅱ,10 patients were grade Ⅲ,2 patients were grade Ⅳ,the observation group was significantly better than the control group(P＜0.05).Conclusion The pelvic autonomic nerve preservation in the total mesorectal excision for low rectal cancer is feasible,it can reduce postoperative complications,promote the rehabilitation of patients,it is conducive to promote the recovery of urinary function.