保留自主神经的腹腔镜直肠癌切除术效果研究及腹膜后自主神经的筋膜解剖学观察

Clinical effect of autonomic nerve-preserving laparoscopic rectal cancer resection and the clinical observation of fascial anatomy of retroperitoneal autonomic nerve

目的探讨保留自主神经(PANP)的腹腔镜直肠癌切除术的临床效果并阐明腹膜后自主神经的筋膜解剖学表现。方法回顾性分析2016年1月至2019年6月收治行直肠癌切除术治疗的78例中低位直肠癌患者资料,按术式不同将其分为腹腔镜组和开腹组,各39例。其中腹腔镜组行PANP的腹腔镜直肠癌切除术,开腹组行PANP的开腹直肠癌切除术。采用SPSS 22.0统计软件进行数据分析。围术期指标等计量资料用(x±s)表示,采用独立t检验;术后并发症、排尿功能等计数资料采用行χ^2检验,P<0.05差异有统计学意义。结果腹腔镜组手术时间比开腹组长,其余围术期指标均优于开腹组(P<0.05);腹腔镜组残尿量低于开腹组,最大尿流率高于开腹组,排尿功能障碍总发生率显著小于开腹组(P<0.05);腹腔镜组勃起功能障碍与射精障碍总发生率显著低于开腹组(P<0.05)。结论腹腔镜下PANP的直肠癌切除术可取得与开腹手术相近的手术效果,且在改善患者术后排尿功能与性功能方面更具优势,具有较高安全性与可行性。

Objective To investigate the clinical effect of autonomic nerve-preserving laparoscopic rectal cancer resection and to clarify the anatomical manifestations of the retroperitoneal autonomic nerve.Methods From January 2015 to June 2019,retrospective analysis were performed in 78 patients with low and middle rectal cancer who underwent rectal cancer resection in our hospital,who were divided into the laparoscopic group(n=39)and the open group(n=39)by using the random number table method.In the laparoscopic group,autonomic nerve-preserving laparoscopic rectal cancer resection was performed,and in the open group,fascial anatomy of the autonomic nerve was observed during the operation,and the perioperative indexes and postoperative complications were analyzed.The clinical effects by using different surgical methods,including sexual and urination function were compared.Statistical analysis were performed by using SPSS 22.0 software.Perioperative indicators and other measurement data were expressed as (x±s) and were examined by using independent t test.postoperative complications,such as urinary function,were tested by usingχ^2 test.A P value of<0.05 was considered as statistically significant difference.Results The operation time in the laparoscopic group was longer than that in the open group,while the remaining perioperative indexes were better than those in the open group,with statistically significant differences(P<0.05).The residual urine volume in the laparoscopic group was lower than that in the open group,and the maximum urine flow.The rate was higher than those of the open group respectively,and the total incidence of dysuria was significantly lower than that of the open group,with statistically difference(P<0.05).The total incidence of erectile dysfunction and ejaculation were significantly lower in the laparoscopic group than those in the open group respectively,with statistically difference(P<0.05).Conclusion Autonomic nerve-preserving laparoscopic rectal cancer resection could achieve similar surgical results to laparotomy,with advantages such as improving patients’urination and sexual function after surgery.