摘要
目的探讨腹腔镜下保留盆腔自主神经（PANP）的直肠癌根治术对患者术后排尿功能的保护效果。方法对中山大学附属第三医院2005年11月至2007年10月间住院的139例中低位直肠癌患者进行前瞻性对照研究，其中63例行腹腔镜PANP手术（L—PANP组）；76例行开腹PANP手术（O-PANP组）作为对照。分析L—PANP手术的根治性、安全性；通过对患者排尿功能的随访、尿流动力学检查等，评估两种手术方式对患者排尿功能的影响。结果L—PANP组患者术后10d时，Ⅰ型及Ⅱ型术式患者膀胱逼尿肌收缩力下降程度小于O—PANP组同型术式患者（Z=-2．358、P=0．018，Z=-2．268、P=0．033），但两组间行Ⅲ型术式者则差异无统计学意义（Z=-1．302，P=0．237）；术后1个月时，L—PANP组各型术式患者膀胱逼尿肌收缩力下降程度均小于0一PANP手术同型术式患者（均P〈0．05）。L-PANP组和O-PANP组1年生存率分别为98．0％（50／51）和96．6％（57／59），差异无统计学意义（P=0．898）；术后1年的盆腔局部复发率分别为3．9％（2／52）和5．1％（3／59），差异亦无统计学意义（P=0．867）。结论L—PANP手术对患者排尿功能的保护优于O—PANP手术。
Objective To evaluate the protection of urinary function after laparoscopic radical resection with pelvic autonomic nerve preservation （PANP） for rectal cancer. Methods Prospectively 139 patients with middle or low rectal cancer receiving surgery during November 2005 to October 2007 were divided into two groups （ L-PANP, n = 63 ; O-PANP, n = 76）. The radicalism and safety of L-PANP surgery were analyzed and the effects upon urinary function between the two groups assessed by follow-ups and urodynamie study. Results Patients receiving subtypes Ⅰ and Ⅱ of L-PANP surgery had less decrease in contraction of bladder than those receiving the same subtype of O-PANP surgery at 10 days post-operation （Z = - 2. 358, P = 0. 018 ; Z =- 2. 268, P = 0. 033 ）. And no difference was observed in patients receiving subtype Ⅲ PANP surgery （Z = - 1. 302, P -- 0. 237）. However, no matter which subtype of PANP surgery, patients of L-PANP group had a better contraction of bladder than those of O-PANP group at 1 month post- operation （P 〈0. 05）. The l-year survival rate was 98. 0% （50/51） in L-PANP group and 96. 6% （57/ 59） in O-PANP group. And no statistical difference was found between them （P = 0. 898）. Meanwhile, the 1-year relapse rate of pelvic cavity was 3.9% （2/52） in L-PANP group and 5. 1% （3/59） in O-PANP group. And no statistical difference was found between them （P = 0. 867）. Conclusion As compared with O-PANP surgery, L-PANP surgery shows a superiority in protection of urinary function.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2009年第42期2976-2979,共4页
National Medical Journal of China
基金
广东省科技计划项目（2006836002007）
关键词
腹腔镜
直肠肿瘤
尿动力学
排尿障碍
盆腔自主神经保护
Laparoscopes
Rectal neoplasms
Urodynamics
Urination disorders
Pelvic autonomic nerve preservation
