直肠癌全直肠系膜切除术中保留自主神经和保肛手术的体会

Clinical application of pelvic autonomatic nerve preservation and anus reservation following total mesorectum excision

目的 探讨男性直肠癌病人在行全直肠系膜切除术 (TME)的基础上实施保留盆腔自主神经 (PANP)和保肛 ,对于减少病人术后局部复发和性功能障碍及排尿功能障碍的作用。方法 采用病例对照法 ,分析TME基础上直肠癌根治术中保留盆腔植物神经组和不保留组病人术后性功能障碍、排尿功能障碍的发生率及局部复发率。结果 研究组和对照组病人术后勃起功能障碍的发生率分别为 41.6%和 61.1% ,射精功能障碍发生率分别为 47.2 %和 69.4% ,两组比较差异有显著性 (P <0 .0 1)。局部复发率分别为 9%和 5 .6% ,差异无显著性。但吻合口瘘的发生率增高。结论 在TME基础上实施PANP ,在不增加局部复发率的情况下 ,可改善病人术后的性功能和排尿功能 ,提高病人术后的生活质量 ,应同时注意提高吻合技术 。

Objective To evaluate the effects of pelvic autonomatic nerve preservation (PANP) and anus reservation following total mesorectum excision (with) on male patients with rectal cancer to reduce local recurrence rate,sexual and micturation dysfunction.Methods The sexual and micturation dysfunction and local recurrence rate of patients in case and control group were analyzed retrospectively by case-control study.Results The erectile dysfunction rate was 41.6% and 61.1%,the ejaculatory disorder rate was 47.2% and 69.4% in case and control group respectively,with the difference being significant(P<0.01).The local recurrence rate was 9% and 5.6% in case and control group respectively,with the difference being not significant.But the rate of anstotic fistula was increased by 8.3% in case group.Conclusion The PANP following TME for rectal cancer could reduce sexual and micturation disorder rate and improve the quality of life of the patients after operation without increasing local recurrence.