腹腔镜及开腹直肠癌根治术中保留自主神经的效果比较

目的比较腹腔镜及开腹直肠癌根治术中保留自主神经的效果。 方法选取94例直肠癌患者，按随机数表法分为A组与B组，每组47例。A组行保留盆腔自主神经的腹腔镜直肠癌根治术，B组行保留盆腔自主神经的开腹直肠癌根治术。比较两组手术时间、术中出血量、术后镇痛率、肛门排气时间、进食时间、淋巴结清扫个数、近切端长度、远切端长度、环周切缘阳性率、术后排尿功能与性功能。术后进行随访，比较随访期间复发与转移率、死亡率。 结果A组手术时间长于B组(P<0.05)，术中出血量、肛门排气时间、禁食时间均低于B组(P<0.05)，术后镇痛率低于B组(P<0.05)。两组淋巴结清扫个数、近切端长度、远切端长度、环周切缘阳性率等肿瘤学指标的差异均无统计学意义(P>0.05)。两组排尿障碍总发生率接近(P>0.05)，A组尿管拔除时间、残尿量低于B组，自由尿流率高于B组(均P<0.05)。A组术后勃起功能障碍与射精障碍总发生率分别为14.9%、17.0%，均低于B组，且A组整体勃起功能与射精功能优于B组。A组随访期间复发与转移发生率为8.5%、死亡率10.6%；B组复发与转移发生率12.7%，死亡率6.3%，差异均无统计学意义(P>0.05)。 结论腹腔镜下保留盆腔自主神经的全直肠系膜切除术可取得与开腹手术相当的根治效果，且利于清晰地显露手术视野，为盆腔自主神经的识别及护提供了有利条件，改善患者术后排尿功能与性功能，具有较高安全性与可行性。

Clinical comparison of autonomic nerve preservation in laparoscopic and open rectal cancer surgery

ObjectiveTo compare the preservation of autonomic nerve in laparoscopic and open rectal cancer radical surgery. Methods94 patients with rectal cancer were enrolled and divided into group A (47 cases) and group B (47 cases). Patients in group A underwent laparoscopic surgery, while open surgery were performed in group B. During follow-up period, clinical data of patients were compared between two groups, including operation time, intraoperative blood loss, rate of postoperative analgesia, anal exhaust time, recovery time of oral nutrition, lymph node dissection number, proximal length, distal length, positive rate of circumcision, postoperative urinary function and sexual function, recurrence, metastasis and mortality rate. ResultsThe operation time of group A was significantly longer than that of group B (P<0.05), however, the intraoperative blood loss, anal exhaust time and recovery time of oral nutrition were lower than those of group B (P<0.05), and the rate of postoperative analgesia was lower than that of group B (P<0.05). There were no significant differences in terms of harvested lymph node number, length of proximal and distal margin, and positive rate of circumferential margin (P>0.05). Total incidence of urination dysfunction was similar between two groups (P>0.05), the catheter removal time, residual urine of group A were lower than those of group B, and the free urinary flow rate was higher than that of group B (all P<0.05). The total incidence of postoperative erectile dysfunction and ejaculation disorder in group A was 14.8% and 17.0% respectively, which were lower than those in group B (P<0.05). The incidence of recurrence and metastasis was 8.5% and the death rate was 10.6% in group A. The recurrence and metastasis rate in group B was 12.7% and the mortality rate was 6.3%(all P>0.05). ConclusionPelvic autonomic nerve preservation could be achieved in laparoscopic total mesorectal excision as well as open surgery, with clearl expose of surgical field and better identification and protection of pelvic autonomic nerve, which could improve postoperative urination function and sexual function, with high security and feasibility.