4K腹腔镜直肠癌根治术中植物神经保护的研究

Study on the Necessity of Autonomic Nerve Protection in 4K Laparoscopic Radical Surgery for Rectal Cancer

目的:探究植物神经保护在4K腹腔镜直肠癌根治术中的必要性。方法:选取2022年6月至2023年6月许昌市人民医院普外二科收治的98例行4K腹腔镜直肠癌根治术患者,根据术中是否进行植物神经保护分为术中植物神经保护组和术中植物神经未保护组两组,各49例。比较两组患者围手术期指标、肛肠动力学指标、氧化应激指标、炎症因子水平、免疫功能指标、术后并发症发生率以及排尿、勃起、射精功能障碍发生率。结果:术中植物神经保护组患者术中出血量、术后2周、6个月排便次数均少于术中植物神经未保护组,手术、肠功能恢复、住院时间均短于术中植物神经未保护组,差异具有统计学意义(P<0.05)。手术后,术中植物神经保护组患者直肠肛管抑制反应阈值(AIRT)低于术中植物神经未保护组,肛管静息压(ARP)、肛管最大收缩压(MSP)、直肠静息压(RRP)、高压区长度(HPZ)、直肠最大耐受容量(MTV)高于术中植物神经未保护组,差异具有统计学意义(P<0.05)。手术后,术中植物神经保护组患者血清炎症因子水平均低于术中植物神经未保护组,差异具有统计学意义(P<0.05)。手术后,术中植物神经保护组患者血清超氧化物歧化酶(SOD)、外周血簇分化抗原(CD)4^(+)水平、CD4^(+)/CD8^(+)比值高于术中植物神经未保护组,血清丙二醛(MDA)、外周血CD8^(+)水平低于术中植物神经未保护组,差异具有统计学意义(P<0.05)。术中植物神经保护组患者术后并发症发生率以及排尿、勃起、射精功能障碍发生率均低于术中植物神经未保护组,差异具有统计学意义(P<0.05)。结论:在4K腹腔镜直肠癌根治术中,若条件允许,应优先考虑保护患者的植物神经。

Objective To investigate the necessity of autonomic nerve protection in 4K laparoscopic radical surgery for rectal cancer.Methods A total of 98 patients who underwent 4K laparoscopic radical surgery for rectal cancer in the Department of General Surgery II at Xuchang People’s Hospital from June 2022 to June 2023 were selected.They were divided into two groups based on whether autonomic nerve protection was performed during surgery:the autonomic nerve protection group and the nonautonomic nerve protection group,with 49 cases in each group.The perioperative indicators,anorectal dynamic indicators,oxidative stress indicators,levels of inflammatory factors,immune function indicators,incidence of postoperative complications,and the incidence rates of urination,erectile,and ejaculation dysfunction were compared between the two groups.Results The intraoperative blood loss,number of bowel movements at 2 weeks and 6 months postoperatively in the autonomic nerve protection group were less than those in the non-autonomic nerve protection group. The duration of surgery, recovery of bowel function, and hospital stay were shorter in the autonomic nerve protection group than in the non-autonomic nerve protection group, with statistically significant differences (P < 0.05). After surgery, the anorectal inhibitory response threshold (AIRT) in the autonomic nerve protection group was lower than that in the non-autonomic nerve protection group. The anal resting pressure (ARP), maximum systolic pressure (MSP), rectal resting pressure (RRP), high-pressure zone length (HPZ), and maximum rectal tolerance capacity (MTV) were higher than those in the non-autonomic nerve protection group, and the differences were statistically significant (P < 0.05). After surgery, the serum inflammatory factor levels of patients in the autonomic nerve protection group were lower than those in the non-autonomic nerve protection group, and the differences were statistically significant (P < 0.05). Postoperatively, the levels of serum superoxide dismutase (SOD) and cluster of differentiation (CD)4^(+) and the CD4^(+)/CD8^(+) ratio in the autonomic nerve protection group were higher than those in the non-autonomic nerve protection group, while the levels of serum malondialdehyde (MDA) and CD8^(+) were lower, with statistically significant differences (P < 0.05). The incidence of postoperative complications, as well as the incidence rates of urination, erectile, and ejaculation dysfunction in the autonomic nerve protection group, were lower than those in the non-autonomic nerve protection group, with statistically significant differences (P < 0.05). Conclusion In 4K laparoscopic radical resection of rectal cancer, if conditions permit, priority should be given to protecting the patient's autonomic nerve.