摘要
目的探讨腹腔镜下保留盆腔自主神经(PANP)的全直肠系膜切除术(TME)在中低位男性直肠癌中的临床安全性和有效性。方法选择2014年10月~2016年10月在解放军第一六九医院诊断为中低位男性直肠癌的112例患者(AJCC临床分期Ⅰ~Ⅲ)作为研究对象,均接受TME+PANP术式。采用随机数字表法将其分为对照组和观察组,每组各56例,对照组采用开腹法,观察组采用腹腔镜法。比较两组患者的手术相关指标包括平均手术时间、出血量、引流量、置管留置时间、胃肠功能恢复时间、下地活动时间、手术成功率和围术期并发症发生率;比较两组术后1、3 d和7 d视觉模拟量表评分(VAS);至少随访1年,比较两组患者的勃起障碍率、射精障碍率、排尿功能障碍率以及局部复发率。结果两组平均手术时间比较,差异无统计学意义(P>0.05);观察组出血量、引流量、置管留置时间、胃肠功能恢复时间和下地活动时间均显著低于对照组,差异均有统计学意义(P<0.05)。两组手术成功率均为100%,但观察组并发症发生率低于对照组,术后1、3 d和7 d VAS评分均明显低于对照组,差异均有统计学意义(P<0.05)。随访时观察组勃起障碍率、射精障碍率和排尿功能障碍率均明显低于对照组,差异均有统计学意义(P<0.05),但两组局部复发率比较,差异无统计学意义(P>0.05)。结论 腹腔镜下TME+PANP在中低位男性直肠癌中有较好的安全性和有效性,值得临床推广。
Objective To explore the clinical safety and efficacy of total mesorectal excision（TME） with pelvic autonomic nerve preservation（PANP） by laparoscopy in male patients with middle and low rectal cancer. Methods From October 2014 to October 2016, a total of 112 patients diagnosed with middle and low rectal cancer（AJCC clinical stages Ⅰ~Ⅲ） in No.169 Hospital of PLA were selected as the research subjects. All the patients reserved TME＋PANP.They were divided into the control group and the observation group by random number table, with 56 cases in each group. The control group received open surgery and the observation group adopted laparoscopy. The mean operation time, blood loss, drainage volume, indwelling time, gastrointestinal function recovery time and activity time on ground,successful rate of operation and incidence of perioperative complications were compared between the two groups. The scores visual analogue scale（VAS） after operation of 1, 3 d and 7 d were compared between the two groups. The rates of erectile dysfunction, ejaculatory dysfunction, voiding dysfunction and local recurrence were compared between the two groups after at least one year follow-up. Results There was no statistically significant difference in the mean operation time between the two groups（P〈0.05）. The blood loss, drainage volume, indwelling time, gastrointestinal function recovery time and activity time in observation group were all significantly lower than those of control group, with statistically significant differences（P〈0.05）. There were both 100% successful rate of operation in the two groups, but the incidence of complications in the observation group was lower than that of control group, after operation of 1, 3 d and 7 d,VAS scores in observation group were all lower than those of control group, with statistically significant differences（P〈0.05）. The rates of erectile dysfunction, ejaculatory dysfunction and voiding dysfunction in the observation group were all lower than those of contr
作者
徐勇士
龙运志
胡可可
XU Yongshi;LONG Yunzhi;HU Keke(Department of General Surgery,No.169 Hospital of PLA,Hu＇nan Province,Hengyang 421002,China)
出处
《中国医药导报》
CAS
2018年第17期98-101,共4页
China Medical Herald
关键词
腹腔镜
保留盆腔自主神经
全直肠系膜切除术
直肠癌
Laparoscopy
Pelvic autonomic nerve preservation
Total mesorectal excision
Rectal cancer
