直肠癌全系膜切除微创手术对中青年男性盆腔自主神经功能影响的研究

目的:探讨腹腔镜低位直肠癌全系膜切除术对中青年男性盆腔自主神经功能的影响。方法:回顾分析2013年1月至2013年8月93例中青年男性低位直肠癌患者(Dukes B期、C1期)的临床资料,其中49例行腹腔镜保留盆腔自主神经的直肠癌全系膜切除术(观察组),44例行开腹保留盆腔自主神经的直肠癌全系膜切除术(对照组),对比两组患者手术指标、肿瘤学指标、术后排尿障碍及性功能障碍发生率。结果:观察组术中出血量、术后肠道功能恢复时间、术后并发症发生率明显优于对照组,差异有统计学意义(P<0.05);两组切除淋巴结总数(16.6±3.7)vs.(16.9±3.8)]、肿瘤下缘距远切缘的距离(3.9±1.2)cm vs.(4.1±1.3)cm]、术后排尿障碍发生率(16.33%vs.15.91%)、勃起功能障碍率(28.57%vs.27.27%)、射精功能障碍率(24.49%vs.22.73%)差异无统计学意义(P>0.05),远切缘、环周切缘病理均为阴性。结论:为Dukes B期、C1期的低位直肠癌患者行腹腔镜保留盆腔自主神经的全系膜切除术,保留盆腔自主神经功能的效果与开放手术相近,但具有微创的优势,值得临床推广应用。

The research of the effects of minimally invasive surgery of total mesorectal excision on the pelvic autonomic nerve function of young and middle-aged male

Objective ： To evaluate the effects of minimally invasive surgery of total mesorectal excision for low rectal cancer on the pelvic autonomic nerve function of young and middle-aged male. Methods： The clinical data of 93 young and middle-aged male pa- tients with low rectal cancer （ Dukes B and C1 ） from Jan. 2013 to Aug. 2013 were retrospectively analyzed. 49 patients accepted laparo- scopic total mesorectal excision and preservation of pelvic autonomic nerve, as observation group ;44 patients received open total meso- rectal excision and preservation of pelvic autonomic nerve, as control group. The operation indicators, ontology indicators and the inci- dence of postoperative micturition obstacles and sexual dysfunction of the two groups were compared. Results ： The intraoperative blood loss, postoperative intestinal function recovery time and the incidence of postoperative complications of the observation group were supe- rior than those of the control group, the differences were statistically significant （ P 〈 0.05 ）. The total number of harvested lymph nodes in the observation group and control group was （ 16.6 ± 3.7 ） vs. （ 16.9 ± 3.8 ） respectively ; the distance of the inferior edge of tumor to the far cutting edge was （ 3.9 ± 1.2 ） cm vs. （4.1 ± 1.3 ）cm respectively ; the two groups were not statistically significant different （ t = -1. 083, -1. 226 ,P 〉 0.05 ）. The incidence of postoperative urination disorder of the observation group and control group was 16.33% vs. 15.91% respectively, the erectile dysfunction was 28.57% vs. 27.27% respectively, ejaculatory dysfunction was 24.49% vs. 22.73 % respectively, the differences of two groups were not statistically significant （P 〉 0.05 ）. The pathology of the distal cutting edge and circumferential cutting edge were negative. Conclusions ： The effect of the pelvic autonomic nerve preservation in laparoscopic total mesorectal excision in treatment of the low rectal cancer （ Dukes B and C1 ） is similar to op