腹腔镜直肠癌根治术保留盆腔自主神经的临床效果

Outcomes of laparoscopic radical resection of rectal carcinoma with pelvic autonomic nerve preservation

目的观察腹腔镜直肠癌根治术保留盆腔自主神经的临床效果。方法直肠癌患者84例分别采用腹腔镜(观察组,46例)和传统开腹手术(对照组,38例)。两组均行全系膜切除+保留盆腔自主神经的直肠癌根治术。记录两组手术时间、术中出血量和清扫淋巴结数;统计术后尿管拔除时间,术后2周排尿量、残尿量和自由尿流量。随访术后1年,评估患者的生存质量。结果两组手术时间和清扫淋巴结数相仿(P>0.05)。观察组术中出血量少于对照组[(134.83±18.95)ml vs.(231.64±21.87)ml](P<0.05)。观察组术后尿管拔除时间早于对照组[(2.41±1.13)d vs.(4.65±2.34)d](P<0.05)。术后2周,观察组排尿量大[(327.85±37.46)ml vs.(278.53±35.13)ml]、残尿量少[(10.58±3.43)ml vs.(22.13±5.47)ml],自由尿流量多[(28.46±2.65)ml/s vs.(18.94±2.96)ml/s](P<0.05)。术后1年,观察组精神健康、生理功能、社会功能及总体健康评分均优于对照组(P<0.05)。结论与传统开腹手术比较,保留盆腔自主神经的腹腔镜直肠癌根治术创伤小,对排尿功能影响小,能有效改善患者生存质量。

Objective To observe the outcomes of laparoscopic radical resection of rectal carcinoma with pelvic autonomic nerve preservation.Methods Radical resection of rectal carcinoma with pelvic autonomic nerve preservation was performed in 84 patients,of whom 46 cases were operated with laparoscopy（group A）and 38 cases with conventional open surgery（group B）.Operation time,blood loss during surgery and the number of lymph node dissection were recorded.The time of urinary catheter indwelling was calculated.The volume of urination,residual urine and free urine flow were recorded two weeks after operation.The quality of life was evaluated one year later.Results The operation time and the number of lymph node dissection of both groups were similar（P〈0.05）.Compared to group B,group A had less blood loss during operation[（134.83±18.95）ml vs.（231.64±21.87）ml]and the time of urinary catheter indwelling[（2.41±1.13）days vs.（4.65±2.34）days]（P〈0.05）.The volume of urination was more[（327.85±37.46）ml vs.（278.53±35.13）ml],residual urine was less[（10.58±3.43）ml vs.（22.13±5.47）ml]and free urine flow was quicker[（28.46±2.65）ml/s vs.（18.94±2.96）ml/s]two weeks after operation in group A than those in group B（P〈0.05）.The scores of the quality of life one year later were better in group A than those in group B（P〈0.05）.Conclusion Compared to conventional open surgery,the laparoscopic radical resection of rectal carcinoma with pelvic autonomic nerve preservation has less trauma and influence on postoperative urination function and better improvement of the quality of life.