PANP在腹腔镜直肠癌TME中的临床应用
The clinical application of total mesorectal excision with pelvic autonomic nerve preservation under the laparoscope for the male patients
目的 探讨腹腔镜下实施保留男性盆腔自主神经(PANP)的直肠癌全系膜切除术(TME)在临床应用价值及手术技巧，为直肠癌根治术提供参考。 方法 通过回顾性研究对广东省人民医院92例男性直肠癌患者按照手术方式不同分为2组，其中47例观察组患者采取腹腔镜下保留盆腔自主神经全直肠系膜切除术，对照组45例行开腹下保留盆腔自主神经全直肠系膜切除术，比较两组患者手术相关指标、性功能、排尿功能障碍及术后局部复发情况。 结果 ①观察组患者在术中出血量、术后肠功能恢复时间、术后恢复饮食时间和术后下床活动时间明显低于对照组(P<0.05)，在全程手术时间方面高于对照组(P<0.05)，和术后并发症发生率方面无显著性差异(P>0.05)；②术后对患者随访1年，观察组患者在勃起功能障碍、射精功能和排尿功能障碍的发生率明显低于对照组（P<0.05）；两组患者1年后局部复发率无明显差异（P>0.05）。 结论 腹腔镜下实施保留盆腔自主神经全直肠系膜切除术对直肠癌根治术是有益的，能够在根治的基础上，有效减少对患者排尿和性功能的影响，在临床值得进一步推广。
Objective To discuss the clinical application value and operative skills of conducting total mesorectal excision (TME) with pelvic autonomic nerve preservation（PANP） under the laparoscope for male patients, and provide reference for the radical resection of rectal carcinoma. Method According to retrospective study, 92 cases of male rectal carcinoma patients in our hospital were divided into 2 groups according to operation methods. 47 cases as the patients of the observation group are treated with TME with PANP under the laparoscope. 45 cases of the control group are treated with TME with PANP under the laparotomy. the operation-related index, sexual function, urination dysfunction and postoperative local recurrence of the patients in the two groups were compared. Results ① intraoperative volume of blood loss, recovery time of postoperative intestines functions, time of postoperative recovery of eating and drinking, along with time of postoperative activity of the patients of the observation group are evidently lower than patients in the control group (P<0.05). While the whole operation time of the former group was longer than the latter group (P<0.05). There were not significant differences of incidence of postoperative complications between the two groups (P>0.05). ② the patients were followed up after their operations for one year. The occurrence rates of erectile dysfunction, and dysfunction of ejaculation and urination of the observation group patients were significantly lower than patients in the control group（P<0.05）.There were not significant differences of local recurrence rate of the patients of the two groups one year after the operation（P>0.05）. Conclusion Performance of TME with PANP under the laparoscope is beneficial for the radical resection of rectal carcinoma. This method effectively reduces the influence on the urination and sexual function of the patients on the basis of radical treatment. So it is worthy of further promotion.
Colorectal cancer / Pelvic autonomic nerve preservation / Total mesorectal excision / Peritoneoscope
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