直肠癌患者行侧方淋巴结清扫保留植物神经术临床疗效分析

Clinical analysis of rectal cancer patients with lateral lymph node dissection to retain autonomic nerve

目的探讨直肠癌患者行腹腔镜下侧方淋巴结清扫保留植物神经术的临床疗效。方法将40例中低进展期直肠癌患者分为观察组和对照组,每组20例。观察组行腹腔镜下侧方淋巴结清扫保留植物神经术,在清除淋巴结时注意对腹前神经丛、盆神经丛和盆内脏神经的保护。对照组行传统的直肠癌根治术,不作侧方淋巴结清扫。对2组手术时间、出血量、严重并发症、性功能、排尿情况、机体的免疫状况及淋巴结转移率进行比较。结果观察组平均手术时间长于对照组,出血量、平均拔尿管时间和侧方淋巴结转移率均小于对照组(P<0.05);2组性功能比较差别有统计学意义(P<0.05);术后2组患者外周血CD3+、CD4+、IL-6水平较术前均显著升高(P<0.05),术后2组患者IgA、IgM和IgG水平均较术前降低(P<0.05),且2组手术后IgA、IgM和IgG水平比较差别有统计学意义(P<0.05)。结论直肠癌患者行腹腔镜下侧方淋巴结清扫保留植物神经术可减少出血量和手术时间,该方法创伤小,有利于患者术后排尿和性功能的恢复。

Objective To investigate curative effect of laparoscopic rectal cancer patients with lateral lymph node dissection to retain autonomic nerve surgery. Methods Forty patients with rectal cancer were divided into observation group and control group（ n = 20）. Laparoscopic lateral lymph node dissection with the retention of autonomic nerve surgery was given in observation group,and the ventralis anterior nerve plexus,pelvic nerve plexus and pelvic splanchnic nerves were protected at the same time. The conventional radical resection of rectal carcinoma （ without lateral lymph node dissection） was given in control group. Then operative time,blood loss,severe complications,sexual function,urination condition,body immune status and lymph node metastasis rate were compared between two groups. Results The average operative time in observation group was longer than that in control group,blood loss,the plucking urinary canal time and the lateral lymph node metastasis rate were lower than those in control group （ P 0. 05） ; There were statistical significance in sexual function between two groups（ P 0. 05）. Postoperative levels of CD3 ＋ ,CD4 ＋ and IL-6 in peripheral blood were higher than before operation between two groups （ P 0. 05）. Postoperative levels of IgA,IgM and IgG were lower than before operation （ P 0. 05） ,and there were statistical significance in postoperative levels of IgA,IgM and IgG between two groups （ P 0. 05）. Conclusion Laparoscopic lateral lymph node dissection with the retention of autonomic nerve surgery in rectal cancer patients reduces the blood loss and the operative time and has the advantage of minimal trauma so it can be favorable for postoperative recovery of miction and sexual function.