保留盆腔自主神经的全直肠系膜切除术在男性直肠癌保肛术中的应用研究

The research of pelvic autonomic nerve preservation and total mesorectal excision for male rectal carcinoma patients with preserving anus

背景与目的:中低位直肠癌根治术术后常出现严重的与自主神经损害有关的泌尿生殖功能障碍,全直肠系膜切除术(total mesorectal excision,TME)可使上述问题得到一定程度的改善,但排尿功能障碍和性功能障碍仍是术后比较常见的问题。本文旨在探讨保留盆腔自主神经(pelvic autonomic nerve preservation,PANP)的全直肠系膜切除术在男性直肠癌患者低位保肛术中的应用。方法:通过分析保留盆腔自主神经的全直肠系膜切除(TME+PANP组)和不保留自主神经的全直肠系膜切除(TME组)在男性直肠癌患者保肛手术中的应用,对两组患者术后的性功能、排尿功能、局部复发率和5年生存率进行比较。结果:TME组和TME+PANP组的局部复发率、5年生存率差异无统计学意义(P>0.05),PANP+TME组的性功能、排尿功能优于TME组,PANP手术分型与性功能、排尿功能呈正相关(P<0.05)。结论:TME+PANP的直肠癌根治术既保证根治,又降低了排尿障碍和性功能障碍的发生率,PANP手术保留神经越完整,手术后排尿障碍、性功能障碍的发生率越低。

Background and purpose：Genitourinary dysfunction usually occurred in low and middle rectal carcinoma patients after radical resection due to autonomic nervous system damaged.This problem has been ameliorated through the clinical application of total mesorectal excision （TME）,but unfortunately sexual and urinary dysfunction were still relatively common problems post surgery.This article aimed to study the effects of pelvic autonomic nerve preservation （PANP） and the effects of total mesorectal excision （TME） in male patients with rectal carcinoma for purpose of preserving the anus.Methods：The sexual function,urinary function,local recurrence rate and 5-year survival rate were analyzed among the two groups：the pelvic autonomic nerve preservation （PANP＋TME） group and total mesorectal excision （TME） group.Results：Local recurrence and 5-year survival rate were not signifi cantly different between the TME and TME＋PANP groups （P0.05）.Sexual function and urinary function of the PANP＋TME group were both better than the TME group whereas the chosen PANP surgery type,sexual function and urinary function were all positively correlated （P0.05）.Conclusion：PANP combined with TME of rectal cancer can not only guarantee the effects of radical surgery,but reduced the incidence of sexual and urinary dysfunction.However,the more complete pelvic autonomic nerve preservation is,the lower the rate of sexual and urinary dysfunction will be.