3D与2D腹腔镜保护盆腔自主神经的全直肠系膜切除术对比分析

Comparison on clinical efficacy of total mesorectal resection and pelvic autonomic nerve protection with three-dimensional or two-dimensional laparoscopy

目的:分析并比较3D和2D腹腔镜在全直肠系膜切除术(total mesorectal excision,TME)+保护盆腔自主神经(pelvic autonomic nerve protection,PANP)的临床疗效。方法:回顾性分析2016年6月至2021年6月于上海中医药大学附属岳阳中西医结合医院收治的129例行腹腔镜TME+PANP男性直肠癌患者的临床资料,其中54例行3D腹腔镜为观察组、75例行2D腹腔镜为对照组。观察指标包括两组患者一般情况、术中情况、术后并发症情况、排尿功能、性功能及随访情况。结果:129例患者均完成腹腔镜手术,无中转开腹或死亡。观察组外科医生主观评价图像质量、腹腔内操作、深度知觉评分均高于对照组(P<0.05)。两组术后总并发症发生率无显著性差异(P=0.530)。术后6个月,观察组排尿功能评级Ⅰ级和Ⅱ级所占比例较高(P<0.05)。结论:3D腹腔镜系统较2D腹腔镜系统能够获得更加清晰立体的画面、提供更强的深度知觉,在TME+PANP直肠癌根治术中能够降低男性患者术后排尿功能障碍发生率。

Objective:To analyze and compare the clinical efficacy of three-dimensional(3D)and two-dimensional(2D)laparoscopy in total mesorectal resection(TME)and pelvic autonomic nerve protection(PANP).Methods:A retrospective analysis was conducted based on the clinical data of 129 male patients with rectal cancer treated with laparoscopic TME+PANP at Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,from June 2016 to June 2021.Among them,54 patients underwent 3D laparoscopy and were assigned to the observation group;75 patients who underwent 2D laparoscopy formed the control group.The observation indicators were general condition,intraoperative condition,postoperative complications,urination function,sexual function,and follow-up status of the two groups.Result:All 129 patients completed laparoscopic surgery without any conversion to open surgery or death.The subjective evaluations of image quality,intraperitoneal operation,and depth perception scores by the observation group surgeons were higher than those of the control group ones(P<0.05).There was no statistically significant difference in the incidence of postoperative complications between the two groups(P=0.530).At 6 months after surgery,the observation group had a higher proportion of patients with urinary function ratings of grades I andⅡ(P<0.05).Conclusions:The 3D laparoscopic system can obtain clearer and more stereoscopic images,provide stronger depth perception,and reduce the incidence of postoperative urinary dysfunction in male patients undergoing TME+PANP for rectal cancer compared to the 2D system.