直肠上动脉亚甲蓝灌注在新辅助放化疗后腹腔镜直肠癌手术中的应用

Application of superior rectal arterial injection of methylene blue during laparoscopic rectal cancer resection after neoadjuvant chemoradiotherapy

目的:探讨新辅助放化疗后腹腔镜直肠癌根治术中采用直肠上动脉亚甲蓝灌注对淋巴结检出数及男性直肠癌患者术后性功能、排尿功能改变的影响。方法:选择2013年3月—2017年4月期间湘潭市中心医院胃肠外科和中山市陈星海医院接受新辅助同步放化疗及腹腔镜根治性切除手术的96例男性直肠癌患者临床资料,随机分为试验组和对照组,每组48例,试验组根治术前经直肠上动脉内注射1%亚甲蓝8mL,对照组直接行根治术。比较两组患者淋巴结的清扫数目及术后性功能(包括射精功能和勃起功能)、排尿功能的变化。结果:两组间手术方式无统计学差异(P=0.408);试验组患者淋巴结清扫数目多于对照组[(15.04±4.063)枚vs.(12.23±2.991)枚,P<0.05]。试验组与对照组患者术后1年Ⅰ、Ⅱ、Ⅲ级射精功能例数分别为41(85.4%)、7(14.6%)、0(0)与31(64.6%)、13(27.1%)、4(8.3%);术后1年Ⅰ、Ⅱ、Ⅲ级勃起功能例数分别为42(87.5%)、6(12.5%)、0(0)与32(66.7%)、15(31.3%)、1(2.1%);术后Ⅰ、Ⅱ、Ⅲ、Ⅳ级排尿功能例数分别为35(72.9%)、12(25.0%)、1(2.1%)、0(0)与26(54.2%)、13(27.1%)、5(10.4%)、4(8.3%)。统计分析结果显示,试验组术后1年的射精功能、勃起功能、排尿功能均明显优于对照组(均P<0.05)。结论:新辅助放化疗后行腹腔镜直肠癌根治术,直肠上动脉灌注亚甲蓝能清晰区分手术界面,能增加淋巴结检出率,减少盆神经的损伤,降低男性患者术后性功能障碍及排尿功能障碍发生率。

Objective： To investigate the influences of using methylene blue injection into the superior rectal artery during laparoscopic rectal resection after neoadjuvant chemoradiotherapy on number of harvested lymph nodes and postoperative male sexual function and urination fianction in male rectal cancer patients.Methods： Ninety-six rectal cancer male patients undergoing laparoscopic radical resection after synchronous neoadjuvant chemotherapy and radiotherapy in Xiangtan Central Hospital and Chen Xinghai Hospital during March 2013 to April 2017 were enrolled. The patients were randomly assigned to study group and control group, with 48 cases in each group. Patients in study group were injected with 8 mL of 1% methylene blue into the superior rectal artery prior to radical resection, and those in control group underwent radical surgery directly. The numbers of lymph node dissected, and postoperative sexual function （including erection and ejaculation） and urination function between the two groups of patients were compared.Results： There was no significant difference in the procedures performed in the two groups （P〉0.05）. The number of lymph nodes removed was significantly higher in study group than that in control group （15.04±4.063 vs. 12.23±2.991, P〈0.05）; the numbers of cases with grade/, Ⅱ and Ⅲ postoperative/-year ejaculation function were 41 （85.4%）, 7 （14.6%） and 0 （0） in study group, and were 31 （64.6%）, 13 （27.1%） and 4 （8.3%） in control group, the numbers of cases with grade Ⅰ, Ⅱ, Ⅲ postoperative 1-year erection function were 42 （87.5%）, 6 （12.5%） and 0 （0） in study group and were 32 （66.7%）, 15 （31.3%） and 1 （2.1%） in control group, and the numbers of cases with grade I, II, III and IV postoperative 1-year urination function were 35 （72.9%）, 12 （25.0%）, 1 （2.1%） and 0 （0） in study group and were 26 （54.2）, 13 （27.1%）, 5 （10.4%） and 4 （8.3%） in control group. The results of statistical analysis showed the postoperative 1-year ejaculation function, erection function and urination function were significantly superior in study group than those in control group （all P〈0.05）.Conclusion＂ For rectal cancer patients undergoing radical resection after neoadjuvant chemoradiotherapy, methylene blue injection into the superior rectal artery can help to clarify the surgical plane and increase the lymph node dissection rate as well as reduce damages of the pelvic nerves, and thereby protect the sexual function and urinary function of male patients.