应用全直肠系膜切除和保留植物神经的三腔清扫技术治疗中晚期直肠癌247例

 【摘要】　目的　分析应用全直肠系膜切除（TME）、保留植物神经（PANP）的三腔清扫（TSD）技术治疗中晚期直肠癌的效果。方法　247例中晚期直肠癌患者采用TME和（或）TSD技术行根治性切除。其中,185例（74.9 %）进行了PANP（P组）的直肠癌根治术治疗,其余患者由于怀疑侵犯植物神经丛而行植物神经非保留式（P-组）切除术,P组中行TME者139例（Pm组）,行TSD者46例（Ps组）。结果　247例患者中无手术死亡病例。Pm组在手术时间、手术操作难度等方面优于Ps组（P ＜0.05）。P组在术后泌尿和性功能上明显好于P-组（P <0.05）。P组与P-组、Pm组与Ps组在肛门直肠功能、2年生存率及远期复发率、转移率及生存期等方面差异均无统计学意义（均P >0.05）。结论　TME技术PANP对绝大多数中晚期直肠癌均是应该优先选择的术式,应争取行"三明治"疗法。TSD手术操作相对复杂。TME、TSD的术后生存率差异无统计学意义,术后生存期主要取决于癌肿的早期发现与干预。

TME or TSD with pelvic autonomic nerve preserving operation for 247 patients with advanced rectal cancer

【Abstract】　Objective　To investigate effects of rectal cancer to undergo total mesorectal excision(TME) or three space dissection(TSD) with pelvic autonomic nerve preservation(PANP). Methods　TME or/and TSD was applied in 247 Patients with advanced rectal cancer in which 185 cases （74.9 %） underwent PANP (Group P) including TME-PANP(Group Pm) 139 cases and TSD-PANP(Group Ps) 46 cases. The other 62 cases underwent none-PANP(Group P-) due to tumor invasion. Results　There were no death cases for operation in all patients. Group Pm was better than Group Ps in the operation time and the difficulty of proce－dure（P <0.05）. Group P was better than Group P- in the post-operation urinary and sexual function（P <0.05）. The differences were no defective in anorectal function, the rate of 2-year survival and local recur－rences（P >0.05）. Conclusion　The procedure with TME to preserve pelvic autonomic nerves adapts to the majority of rectal cancer patients. TSD procedure is more complex than TME. Statistically, the survival differ－ence between Patients with TSD and with TME is no defective. The survival time is determined to the tumor's earlier diagnosis and therapy.