摘要
结直肠癌是全球常见的恶性肿瘤之一,其主要治疗策略是以手术为核心的综合治疗。直肠癌根治术后常见的泌尿生殖系统功能障碍成为困扰患者的重要问题,特别是男性功能的损伤,严重影响手术后患者的生活质量。部分患者因为担心性功能和泌尿功能受损而放弃直肠癌的根治手术。造成这一问题的原因,是术中盆腔自主神经的损伤。其中骨盆自主神经的保留主要是下腹神经,其主要负责男性射精功能。骨盆内脏神经主要司男性阴茎的勃起。本文对这两种神经的解剖来源、分布及其对相关的泌尿生殖功能的影响进行详细阐述,并介绍有关保留自主神经的手术分类、操作要点和效果评估。在微创外科快速发展的今天,在实施直肠癌根治手术的同时,充分了解盆腔自主神经的解剖学概念,应用现代微创外科手术技术实现对患者骨盆自主神经的保留,是结直肠外科医师的重要必修课程,也是直肠癌外科手术规范化的重要体现。
Colorectal cancer is one of the most common cancers in the world,and surgery is the mainstage treatment.Urogenital and sexual dysfunction after radical resection of rectal cancer has become an important problem for patients,which seriously affects the quality of life.Some patients give up radical surgery for rectal cancer because of the concerns about sexual and urinary dysfunction.The cause of this problem is intraoperative of injury pelvic autonomic nerve.The preservation of the hypogastric nerve during the surgery is important for the male ejaculation.Pelvic splanchnic nerves are mainly responsible for the male erection.The anatomical origin,distribution,and urogenital function of these two nerves are detailed described in this article.At the same time,this article introduces the classification,key points of the operation and the evaluation of autonomic nerve preservation surgery.With the rapid development of minimally invasive surgery,performing radical surgery for rectal cancer is important,we also need to fully understand the anatomical concept of pelvic autonomic nerves,and apply modern minimally invasive surgical techniques to preserve the patient's pelvic autonomic nerves as well.It is an compulsory course and an important manifestation for the standardization of rectal cancer surgery.
作者
翟志超
张卫光
顾晋
Zhai Zhichao;Zhang Weiguang;Gu Jin(Department of Gastrointestinal Surgery,Peking University Shougang Hospital,Beijing 100144,China;Department of Gastrointestinal Surgery III,Peking University Cancer Hospital&Institute,Beijing 100142,China)
出处
《中华胃肠外科杂志》
CSCD
北大核心
2023年第1期68-74,共7页
Chinese Journal of Gastrointestinal Surgery
关键词
结直肠肿瘤
盆腔自主神经
解剖
Colorectal neoplasms
Pelvic autonomic nerve
Anatomy
