全直肠系膜切除术中保留植物神经临床疗效分析

The Effective Analysis on Total Mesorectal Excision with Pelvic Autonomic Nerve Preservation in Treatment of Rectal Neoplasms

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),对于减少性功能障碍及排尿功能障碍的作用。方法随机将120例病人分为2组,观察TME基础上保留盆腔植物神经(TME+PANP)组(65例)和不保留植物神经(TME)组(55例)病人术后性功能障碍、排尿功能障碍、吻合口瘘的发生率,随访2年观察局部复发率。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21.5%(14/65)和41.8%(23/55),射精功能障碍发生率分别为23.1%(15/65)和45.5%(25/55),两组比较差异均有显著性(P<0.05)。术后导尿时间分别为5.5±3.4d和10.8±4.8d,两组比较差异均有显著性(P<0.05)。吻合口瘘的发生率分别为4.6%(3/65)和3.6%(2/55),局部复发率分别为6.2%(4/65)和5.5%(3/55),两组比较差异均无显著性(P>0.05)。结论在TME基础上实施PANP,在不增加吻合口瘘发生率和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。

Objective To evaluate the clinical effect of total mesorectal excision with pelvic autonomic nerve preservation in treatment of rectal neoplasms. Methods 120 cases with rectal cancer were randomly divided into two groups . A group with 65 patients underwent total mesorectal excision and pelvic nerve preservation,B group with 55 patients underwent total mesorectal excision. Sex function ,micturition function, rate of stoma fistula and local recurrence rates were investigated respectively. Results Erection function and ejaculation function was damaged in both group A（21.5% cases , 23. 1% cases） and group B（41.8 % cases,45.5 % cases） , the time of urethral catheterization was 5.5±3.4 days in group A and 10. 8 ±4.8 days in group B. These differences were significant（P（0.05）. The rate of anastomotic stoma fistula was 4.6% in group A and 3.6 % in group B, The rate of local recurrence was 6.2 % in group A and 5.5 % in group B. These differences were insignificant（P〉0.05 ）. Conclusion Total mesorectal excision with pelvic nerve peservation can decrease the rate of sex function damadge and micturition function damadge without increasing the rate of anastomotic stoma fistula and the rate of local recurrence. It can improve life quality of post--operation.