保留盆腔自主神经的直肠癌根治术研究进展

Application status and progress of intraoperative nerve monitoring in pelvic autonomic nerve preserving radical resection of rectal cancer

目前直肠癌的治疗策略是以手术为核心的综合治疗。全直肠系膜切除术(TME)的应用明显降低了局部复发率,改善了患者的生存预后,但术中盆腔自主神经损伤带来的一系列盆腔脏器功能障碍会降低患者术后生活质量,保留盆腔自主神经(PANP)的直肠癌根治术应运而生,但该技术实施过程中的最大难点在于对神经的准确识别。已有一系列研究表明,术中盆腔自主神经监测(pIONM)可以有效地帮助术者识别神经。本文旨在介绍盆腔自主神经的功能、术后盆腔功能障碍的临床表现及其与神经损伤的关系、实施PANP的操作要点及pIONM的技术应用现状及研究进展。

The current treatment strategy for rectal cancer is a comprehensive treatment centered on surgery.The application of total mesorectal excision(TME)has significantly reduced the local recurrence rate and improved the survival prognosis,but a series of pelvic organ dysfunction caused by pelvic autonomic nerve injury during the operation will reduce the postoperative quality of life of patients.Pelvic autonomic nerve preserving(PANP)radical proctectomy has emerged,but the biggest challenge in the implementation process of this technology is the accurate identification of nerves.A series of studies have shown that pelvic intraoperative autonomic monitoring(pIONM)can effectively assist surgeons to identify nerves,The purpose of this article is to introduce the function of pelvic autonomic nerve,the clinical manifestation of postoperative pelvic dysfunction and its relationship with nerve injury,the key points of implementing PANP,and the current situation and research progress of pIONM technology application.