腹腔镜下系统保留盆腔自主神经的直肠癌根治术的近期疗效及对患者术后排尿、胃肠功能影响

Short-term Efficacy of Laparoscopic Radical Resection of Rectal Cancer with Pelvic Autonomic Nerve Preservation and its Effect on Postoperative Urination and Gastrointestinal Function

目的探讨在腹腔镜下系统保留盆腔自主神经的直肠癌根治术的近期疗效及对患者术后排尿、胃肠功能影响。方法选取直肠癌患者78例,随机数字法均分为观察组和对照组。所有入组患者均行腹腔镜下直肠癌根治术,观察组术中保留盆腔自主神经,对照组不保留。比较两组患者的近期疗效和术后排尿、胃肠功能差异。结果观察组术中出血量为(156.56±32.35)ml,低于对照组,P<0.05;观察组术中清扫淋巴结数(23.96±5.86)个,高于对照组,P<0.05。观察组拔尿管时间、肠鸣音恢复时间、排气时间、排便时间、术后下床活动时间及住院时间均短于对照组,P<0.05。术后3 d,观察组CRP、Cor水平低于对照组,PA水平高于对照组,P<0.05;观察组MLT、GAS水平分别为(108.6±32.3)pg/ml、(229.6±36.9)pg/ml,均高于对照组,P<0.05。术后2周,观察组排尿功能障碍发生率为5.13%(2/39),低于对照组15.38%(6/39),χ^2=4.365,P=0.019。术后3个月,观察组排尿障碍发生率为2.56%(1/39)低于对照组15.38%(6/39),χ^2=4.590,P=0.008。观察组性功能障碍发生率显著低于对照组,P<0.05。结论腹腔镜下保留盆腔自主神经的直肠癌根治术的近期疗效较好,并有效降低术中神经损伤导致的排尿、胃肠功能障碍。

Objective To investigate the short-term effect of laparoscopic radical resection of rectal cancer with pelvic autonomic nerve preservation and its effect on urination and gastrointestinal function after operation.Methods 78 patients with rectal cancer were randomly divided into the observation group and the control group.Laparoscopic radical resection of rectal cancer was performed in all patients.Pelvic autonomic nerve was preserved in the observation group and not in the control group.The short-term curative effect,urinary function and gastrointestinal function were compared between the 2 groups.Results The intraoperative blood loss was(156.56±32.35)mL in the observation group,which was lower than that of the control group(P<0.05).In the observation group,the lymph node dissection(23.96±5.86)was higher than the control group,P<0.05.The time of extubation,recovery of bowel sounds,exhaust time,defecation time,time of getting out of bed and hospital stay in the observation group were significantly shorter than those of the control group(P<0.05).At 3 days after operation,the levels of CRP and Cor in the observation group were lower than those of the control group,and the PA level was higher than that of the control group(P<0.05).The MLT and GAS levels in the observation group were(108.6±32.3)pg/ml,(229.6±36.9)pg/ml was higher than the control group,P<0.05.At 2 weeks postoperatively,the incidence of urinary dysfunction in the observation group was 5.13%(2/39),which was lower than that of the control group(15.38%(6/39),χ^2=4.365,P=0.019).At 3 months after operation,the incidence of urinary dysfunction in the observation group was 2.56%(1/39)lower than that of the control group(15.38%(6/39),χ^2=4.590,P=0.008).The incidence of sexual dysfunction in the observation group was significantly lower than that of the control group.Conclusion The short-term effect of laparoscopic resection of rectal cancer with pelvic autonomic nerve is better,and it can effectively reduce urinary and gastrointestinal dysfunction caused by intraoperative nerve injury.