经“Holy plane”间隙保留盆腔自主神经侧方淋巴结清扫术的临床观察

Preserving pelvic autonomic nerve and lateral lymph node dissection in lower rectal cancer through the 'Holy Plane'

目的探讨经"Holy plane"间隙保留盆腔自主神经(HPANP)侧方淋巴结清扫术在男性直肠癌低位保肛术中的临床应用价值。方法比较传统手术与HPANP侧方淋巴结清扫术在男性直肠癌低位保肛术中的应用情况,对各组患者的排尿功能、性功能、局部复发率和3年生存率等指标进行分析、评价。结果 HPANP侧方淋巴结清扫术组肿瘤下缘距肛门距离较传统手术组明显缩短(P<0.05);术后排尿障碍、勃起障碍、射精障碍的发生率均低于传统手术组,组间比较差异有统计学意义(P<0.05);HPANP手术术式分型与排尿障碍、勃起障碍、射精障碍分级之间呈正相关(P<0.05);两组3年生存率无明显差异;局部复发率HPANP组明显低于传统手术组(P<0.05)。结论 HPANP侧方淋巴结清扫术对降低局部复发率、预防术后排尿障碍、勃起障碍、射精障碍等有较好的临床价值。

Objective To study the value of pelvic autonomic nerve preservation and lateral lymph node dissection through the ＇Holy Plane＇ in male lower rectal carcinoma patients for preserving anus.Methods The distance from tumor＇s edge to anus,3-year survival rate,local recurrence rate,urinary function and sexual function were prospectively analyzed in pelvic autonomic nerve preservation through ＇Holy Plane＇（HPANP）＋lateral lymph node dissection（LLND） group and traditional operation group.Results The distance from tumor＇s edge to anus in HPANP＋LLND group was shorter than that of traditional operation group.Three year＇s survival rate had not significant difference between the two groups.The rate of local recurrence decreased obviously and the rate of urinary dysfunction and sexual dysfunction were gradually reduced from traditional operation group.Conclusion HPANP combined with LLND technique could significantly reduce the local recurrence rate,urinary dysfunction and sexual dysfunction.