腹腔镜直肠癌根治术中保留盆自主神经的关键技术与意义

直肠癌术中盆自主神经(PAN)的损伤是患者术后排尿功能和性功能障碍的主要原因之一。术中盆自主神经的精准辨认和保护始终是直肠癌根治术的要点与难点。术者应熟悉PAN的走行，把握直肠周围筋膜的解剖层次，才能维持正确的外科平面(surgical plane)，最大程度降低盆神经损伤概率。高清腹腔镜设备及应用解剖技术的进展使外科医生更精准地辨认PAN、血管、筋膜等重要解剖结构。本文对腹腔镜下直肠癌根治术中保留PAN的关键技术和意义作一综述。

Techniques and significance of pelvic autonomic nerve preservation in laparoscopic total mesorectal excison for rectal cancer

Intraoperative pelvic autonomic nerve (PAN) damage is major reason of postoperative urogenital dysfunction in treating patients with rectal cancer. The accurate identification and preservation of PAN, which should be tricky during the operation, is the key points of proctectomy. In order to maintain the dissection in the right surgical plane, the surgeon should be familiar with both anatomy of PAN and perirectal fascia, thus could minimize the damage to PAN.Nowadays, by using advanced laparoscopic equipment and evolvement of pelvic anatomical theory, the surgeons could discriminate the configurations of nerves, vessels and fascia in pelvis in a more precise and efficient way. In this review, we stressed the significance of pelvic autonomic nerve preservation in proctectomy for rectal cancer, and discussed a few surgical techniques to do that.