腹腔镜下D3淋巴结清扫联合盆底自主神经保留术在直肠癌患者中应用的疗效及安全性

Analysis of efficacy and safety of laparoscopic lymphadenectomy combined with pelvic autonomic nerve preservation in patients with rectal cancer

目的分析腹腔镜下D3淋巴结清扫联合盆底自主神经保留术在直肠癌患者中应用的安全性及疗效。方法对2015年3月至2016年10月期间彭州市人民医院胃肠外科收治的73例行保留盆底自主神经的直肠癌D3淋巴结清扫术患者的临床资料进行回顾性分析,根据手术方式分为腹腔镜手术组(38例)和开腹手术组(35例),比较2组患者术中及术后的相关指标,同时比较2组男性患者术前及术后1个月时的排尿和性功能情况。结果 (1)2组患者的性别、年龄、肿瘤直径、TNM分期及肿瘤部位比较差异均无统计学意义(P>0.05)。(2)腹腔镜手术组的手术时间要明显长于开腹手术组(P<0.05),但是腹腔镜手术组的术中出血量明显少于开腹手术组(P<0.05),2组患者的淋巴结清扫数目比较差异无统计学意义(P>0.05)。(3)腹腔镜手术组的肛门恢复排气时间和住院时间均明显短于开腹手术组(P<0.05)。腹腔镜手术组患者术后感染、肠粘连及肠梗阻并发症发生率明显低于开腹手术组(P<0.05)。(4)2组内男性患者术后IPSS评分均较术前明显升高(P<0.05)、IIEF-5评分均较术前明显下降(P<0.05),但是2组男性患者术前及术后1个月时的IPSS及IIEF-5评分比较差异均无统计学意义(P>0.05)。结论从本组有限的病例初步得出,腹腔镜下D3淋巴结清扫联合盆底自主神经保留术在直肠癌患者中应用是安全、有效的,相对于传统开腹手术能减轻手术创伤,降低术后并发症发生率,促进术后康复和愈合。

Objective To investigate efficacy and safety of laparoscopic lymphadenectomy combined with pelvic autonomic nerve preservation in patients with rectal cancer. Methods Seventy-three patients underwent D3 radical resection of rectal cancer with pelvic autonomic nerve preservation from March 2015 to October 2016 in the People＇s Hospital of Pengzhou City were collected, then were divided into a laparoscopic surgery group （38 cases） and an open surgery group （35 cases） according to the choice of operation. The intraoperative and postoperative indexes were compared between these two groups, and the urination and sexual functions at preoperation and on month 1 after operation for male patient with rectal cancer were evaluated. Results ① The age, gender, tumor diameter, TNM stage, and tumor location had no significant differences between these two groups （P〉0.05）. ② Compared with the open surgery group, the intraoperative blood loss was less （P〈0.05）, but the operation time was longer （P〈0.05） in the laparoscopic surgery group. The number of lymph node dissection had no significant difference between these two groups （P〉0.05）. ③ The anal exhaust time and hospitalization stay in the laparoscopic surgery group were significantly shorter than those in the open surgery group （P〈0.05）, and the incidences of postoperative infection, intestinal adhesion, and intestinal obstruction were significantly lower in the laparoscopic surgery group as compared with the open surgery group （P〈0.05）. ④ The IPSS score of urination function and the IIEF-5 score of sexual function on month 1 after operation had no significant differences between these two groups （P〉0.05）, but compared with the preoperative points, the IPSS score was significantly increased, the IIEF-5 score was significantly decreased in the same group （P〈0.05）. Conclusion The preliminary results of limited cases in this study show that laparoscopic lymphadenectomy combined with pelvic autonomic nerve preservation in patients with rectal cancer is safe and effective, it has some advantages of mild invasion, lower complication rate, and fast covery.