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目的分析腹腔镜下D3淋巴结清扫联合盆底自主神经保留术在直肠癌患者中应用的安全性及疗效。方法对2015年3月至2016年10月期间彭州市人民医院胃肠外科收治的73例行保留盆底自主神经的直肠癌D3淋巴结清扫术患者的临床资料进行回顾性分析,根据手术方式分为腹腔镜手术组(38例)和开腹手术组(35例),比较2组患者术中及术后的相关指标,同时比较2组男性患者术前及术后1个月时的排尿和性功能情况。结果 (1)2组患者的性别、年龄、肿瘤直径、TNM分期及肿瘤部位比较差异均无统计学意义(P>0.05)。(2)腹腔镜手术组的手术时间要明显长于开腹手术组(P<0.05),但是腹腔镜手术组的术中出血量明显少于开腹手术组(P<0.05),2组患者的淋巴结清扫数目比较差异无统计学意义(P>0.05)。(3)腹腔镜手术组的肛门恢复排气时间和住院时间均明显短于开腹手术组(P<0.05)。腹腔镜手术组患者术后感染、肠粘连及肠梗阻并发症发生率明显低于开腹手术组(P<0.05)。(4)2组内男性患者术后IPSS评分均较术前明显升高(P<0.05)、IIEF-5评分均较术前明显下降(P<0.05),但是2组男性患者术前及术后1个月时的IPSS及IIEF-5评分比较差异均无统计学意义(P>0.05)。结论从本组有限的病例初步得出,腹腔镜下D3淋巴结清扫联合盆底自主神经保留术在直肠癌患者中应用是安全、有效的,相对于传统开腹手术能减轻手术创伤,降低术后并发症发生率,促进术后康复和愈合。
Objective To analyze the safety and efficacy of laparoscopic D3 lymph node dissection combined with pelvic autonomic nerve preservation in patients with rectal cancer. Methods The clinical data of 73 patients with preserved pelvic autonomic rectal cancer who had undergone D3 lymph node dissection admitted to the Department of Gastrointestinal Surgery, Pengzhou People’s Hospital from March 2015 to October 2016 were retrospectively analyzed. According to the surgical methods, Laparoscopic surgery group (38 cases) and open surgery group (35 cases) were compared between the two groups of patients with intraoperative and postoperative related indicators, while two groups of male patients before surgery and 1 month after surgery urination and sex Functional situation. Results (1) There were no significant differences in gender, age, tumor diameter, TNM stage and tumor location between the two groups (P> 0.05). (2) The operative time of laparoscopic surgery group was significantly longer than that of open surgery group (P <0.05), but the intraoperative blood loss of laparoscopic surgery group was significantly less than that of open surgery group (P <0.05) The number of lymph node dissection was no significant difference (P> 0.05). (3) The time of anus recovery exhaust and hospital stay in laparoscopic surgery group were significantly shorter than those in open surgery group (P <0.05). The incidence of postoperative infection, intestinal adhesion and intestinal obstruction in laparoscopic surgery group was significantly lower than that in open surgery group (P <0.05). (4) The postoperative IPSS scores of male patients in both groups were significantly higher than those before operation (P <0.05), and the scores of IIEF-5 were significantly lower than those before operation (P <0.05) There was no significant difference in IPSS and IIEF-5 scores at one month after operation (P> 0.05). Conclusions From the limited cases of this group, we conclude that laparoscopic D3 lymph node dissection combined with pelvic autonomic nerve preservation is safe and effective in patients with rectal cancer. Compared with traditional laparotomy, traumatic surgery can be reduced and postoperative Complication rate, promote postoperative recovery and healing.