神经层面在腹腔镜直肠癌手术中对盆腔自主神经保护的意义

Significance of nerve plane in the preservation of pelvic autonomic nerves during laparoscopic total mesorectal excision for rectal cancer

全直肠系膜切除术(total mesorectal excision, TME)是中低位直肠癌的标准手术方式,尽管直肠癌病人手术后的生存率得到大幅度提高,然而手术导致的器官功能障碍已成为影响病人术后生活质量的重要问题,主要包括术后排粪、排尿以及性功能障碍,其主要原因为术中盆腔自主神经的损伤。神经层面作为盆腔自主神经保护关系密切的重要解剖结构近年来逐步受到重视。该文拟从胚胎发育解剖理念来重点介绍腹腔镜直肠癌根治术中,如何正确辨识神经层面,实现盆腔自主神经保护,从而阐述神经层面在腹腔镜直肠癌手术中对盆腔自主神经保护的意义及研究前景。

Total mesorectal excision(TME) has been the standard surgical procedure for mid-low rectal cancer. Although the survival rate of rectal cancer patients has been greatly improved after surgery, postoperative organ dysfunction has become an important problem affecting patients′ quality-of-life, including bowel, urinary, and sexual dysfunction, which is mainly caused by intraoperative damage to the pelvic autonomic nerve. This review summarized how to correctly identify nerve plane and achieve pelvic autonomic nerve preservation from the concept of embryonic developmental anatomy during laparoscopic rectal cancer surgery, and also further demonstrated the significance and research prospect of nerve plane in pelvic autonomic nerve preservation during laparoscopic rectal cancer surgery.