基于TME技术的直肠癌根治术中保留植物神经的临床体会

The clinical analysis on total mesorectal excision with autonomic nerve preservation in rectal cancer

目的:讨论基于全直肠系膜切除(TME)的直肠癌保留植物神经根治术对男性局部复发率、生存率和术后生活质量的影响。方法:回顾性分析193例应用TME技术的直肠癌根治术的临床资料,其中保留植物神经根治术128例与传统直肠癌根治术(未保留)65例,比较两组患者的局部复发率、5年生存率及术后排尿功能和性功能。结果:两组均顺利完成手术,其中保留植物神经组105例获得随访,传统手术组53例获得随访。局部复发率保留植物神经组为8.57%(9/105),传统术式组为11.32%(6/53);5年生存率保留植物神经组为62.86%(66/105),传统术式组为52.83%(28/53),两组比较差异无统计学意义(P>0.05)。排尿功能障碍保留植物神经组为29.52%(31/105),传统术式组为66.04%(35/53);勃起功能障碍保留植物神经组为22.86%(24/105),传统术式组为69.81%(37/53);射精功能障碍保留植物神经组29.52%(31/105),传统术式组73.58%(39/53),两组比较差异有统计学意义(P<0.05)。结论:TME保留植物神经的直肠癌根治术在不增加局部复发率和不降低5年生存率的同时,可以减少患者排尿功能和性功能障碍的发生,提高患者术后的生存质量。

Objective：To consider the relationship to rate of local recurrence,rate of survival and quality of life underwent total mesorectal excision with autonomic nerve preservation in rectal cancer.Methods：By contrasted,a retrospective evaluation of TME-ANP surgery or radical operation without ANP on rate of local recurrence,a rate of 5-year survival and urinary function and sexual function were performed.TME-ANP surgery and conventional radical operation were performed on 128 cases and 65 cases were rectal cancers respectively.Results：All of the cases were completed successfully.The rate of local recurrence,the TME-ANP group was 8.57%（9/105）,and the conventional radical operation group was 11.32%（6/53）,P0.05.For the rate of 5-year survival,the TME-ANP group was 62.86%（66/105）,and the conventional radical operation group was 52.83%（28/53）,P0.05.For the injured urinary function,the group of TME-ANP was 29.52%（31/105）,and the conventional radical operation group was 66.04%（35/53）,P0.05.For the erectile dysfunction,the group of TME-ANP was 22.86%（24/105）,and the conventional radical operation group was 69.81%（37/53）,P0.05.For the ejaculatory disorder,the group of TME-ANP was 29.52%（31/105）,and the conventional radical operation group was 73.58%（39/53）,P0.05.Conclusion：The total mesorectal excision with autonomic nerve preserwation in rectal cancer are associated with insignificantly higher rate of local recurrence,a insignificantly lower rate of 5-year survival,a better life quality.