The clinical application of total mesorectal excision with pelvic autonomic nerve preservation under the laparoscope for the male patients
ZHONG Dao-Meng, TAO Hua-Qing
Chinese Journal of Clinical Anatomy ›› 2014, Vol. 32 ›› Issue (4) : 462-466.
The clinical application of total mesorectal excision with pelvic autonomic nerve preservation under the laparoscope for the male patients
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
[1] 李欣欣, 宋新明, 陈志辉, 等. 直肠癌术后生活质量研究的随访情况分析
[J]. 中华胃肠外科杂志, 2013,16(8):744-747.
[2] Moore HG, Riedel E, Minsky BD, et al. Adequacy of 1-cm distal margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined-modality therapy
[J]. Ann Surg Oncol, 2003, 10(1):80-85.
[3] 王世栋.直肠固有筋膜的解剖学与MRI对比观察
[D].安徽医科大学, 2011.
[4] Branagan G, Chave H, Fuller C, et al. Can magnetic resonance imaging predict circumferential margins and TNM stage in rectal cancer
[J]. Dis Colon Rectum, 2004, 47(8):1317-1322.
[5] 傅红, 师英强. 再谈直肠癌全系膜切除的几个关键问题—直面Bill Heald教授
[J]. 中国实用外科杂志, 2006, 26(9):710-712.
[6] 肖毅,孙曦羽,牛备战, 等.掌握腹腔镜结直肠手术技术—从起步到熟练的个人经验
[J].中华外科杂志, 2012, 50(12):1063-1067.
[7] Saito N，Sarashina H，Nunomura M，et al．Clinical evaluation of nerve-sparing surgery combined with preoperative radiotherapy in advanced rectal cancer patients
[J].Am J Surg,1998,175(4):277-282．
[8] Ridgway PF, Darzi AW. The role of total mesorectal excision in the management of rectal cancer
[J].Cancer Control, 2011, (9):732-733.
[9] The Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer
[J]. New England Journal of Medicine, The .2012(12):843-845.
[10]Havenga K, Enker WE, Mc Dermott K, et al. Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum
[J]. J Am Coll Surg, 1996, 182(6):495-502.
[11] The Clinical Outcomes of Surgical Therapy Study Group．A comparison of laparoscopically assisted and open coleetomy for colon canoe
[J]．N Engl J Med，2004,350(20):2050-2059．
[12]Trastulli S, Cirocchi R, Listorti C, et al. Laparoscopic vs open resection for rectal cancer: a meta-analysis of randomized clinical trials
[J]. Colorectal Dis, 2012,14(6):277-296.
[13]Lindsey I, Guy RJ, Warren BF. Anatomy of Denonvillier’s fascia and pelvic nerver, importance, and implications for colorectal surgeon
[J].Br J Surg, 2000, 87(10):1288-1299.
[14] 杨晓飞, 李国新, 钟世镇, 等. 肠系膜下动脉根部自主神经保护的解剖学基础
[J].中国临床解剖学杂志, 2013, 31(5):497-500.
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