保留盆腔自主神经的腹腔镜全直肠系膜切除术治疗男性中低位直肠癌

为探讨保留盆腔自主神经的腹腔镜全直肠系膜切除术（TME）治疗男性中低位直肠癌的可行性和手术路径，回顾分析42例腹腔镜下行保留盆腔自主神经的TME的男性中低位直肠癌患者资料。结果显示，全组无中转开腹，手术时间120～285min，平均（217．1±53．9）min；出血量5～550ml，中位数65（32～100）ml。切除淋巴结2～38枚，平均（12．0±5．0）枚。肛门排气时间为1～7d，平均（3．3±0．9）d。可下地行走时间为2～4d，平均（2．5±0．4）d。术后住院时间为8～54d，平均（14．9±6．1）d。术后并发症总发生率为28．6％。随访6～42个月，中位随访时间为20（16．3～31．8）个月，随访率92．9％（39／42）。全组除5例出现短期（1个月内）尿潴留外，均无远期排尿功能障碍；2例出现射精功能障碍，1例出现勃起功能障碍。全组无手术死亡病例，1例出现骨转移，现带瘤生存。结果表明，保留盆腔自主神经的腹腔镜TME治疗男性中低位直肠癌在技术上是安全可行的，且具有视野清楚、准确解剖定位的优势。

Saving Pelvic Autonomic Nerve Laparoscopic TME in the Treatment of Male Mid-low Rectal Carcinoma

In order to explore the feasibility of the procedure of saving pelvic autonomic nerve laparoscopic total mesorectal excision（TME） for male mid-low rectal cancer and its operative pathway authors analysed the data of 42 patients,who had been subjected to this procedure, retrospectively. As results,in the 42 patients there was not conversion to open abdomen,operative time was 120-285 min[averaged （217.1±53.9） mini ,bleeding volume was 5-550ml[medium, 65（32-100）ml] ;the number of excised lymph node was 2-38 （averaged 12.0±5.0） ;anal carminative time was 1-7 days[averaged （3.3±0.9） days] ;ambulant time was 2-4 days[averaged （2.5±0.4）days] ;postoperative hospital stay duration was 8-54 days[averaged （14.9±6.1） days]; postoperative incidence of complication was 28. 6%;the patients were followed-up for 6-42 monthes,its medium time was 20（16.3-31.8） months,follow-up rate was 92.9%（39/42）;except for 5 patients had being short-term（done month） retention of urine there was not long-term urination dysfunction,only two cases had ejaculation dysfunction, one case erectile dysfunction; there was not operative death;only in one case had occured bone metastasis,being still survival with neoplasms. Results show that the procedure of saving pelvic autonomic nerve laparoscopic TME for mid-low rectal cancer is safe and feasible,and has the advantage such as clear field and accurate anatomic location.