论文部分内容阅读
目的探讨保留盆腔自主神经(PANP)的全直肠系膜切除(TME)在男性直肠癌低位保肛术中的应用。方法回顾性分析传统手术、TME和PANP+TME在男性直肠癌保肛手术中的应用,对各组病人肿瘤下缘距肛门距离、3年存活率、局部复发率、排尿功能、性功能作一评价。结果TME组和PANP+TME组手术病人的肿瘤下缘距肛门距离较传统手术组明显缩短(P<0·05);3组的3年存活率分析差异无显著性(P>0·05);TME组和PANP+TME组的局部复发率较传统手术组明显降低(P<0·05);传统手术组、TME组、PANP+TME组的排尿障碍、勃起功能障碍和射精功能障碍的发生率逐渐降低,3组间两两比较差异均有显著性(P<0·05)。PANP手术分型与排尿障碍、勃起功能障碍和射精功能障碍分级呈正相关(P<0·05)。结论TME可以降低直肠癌的局部复发率,降低排尿障碍和性功能障碍的发生率;PANP和TME结合使排尿障碍和性功能障碍的发生率更加降低,PANP手术保留神经越彻底,手术后排尿障碍、性功能障碍的发生率越低。
Objective To investigate the application of total mesorectal excision (TEN) with pelvic autonomic nerve preservation (PANP) in low rectal anus preservation of male rectal cancer. Methods A retrospective analysis of traditional surgery, TME and PANP+ TME in male sphincter preserving surgery was conducted. The distance from the lower border to the anus, 3-year survival rate, local recurrence rate, urinary function, and sexual function of each group of patients were compared. Evaluation. Results The distance between the TEM group and the PANP+TME group was significantly shorter than that of the conventional surgery group (P<0.05). The 3-year survival rate of the 3 groups was not significantly different (P>0.05). Local recurrence rate in TME group and PANP+TME group was significantly lower than that in traditional operation group (P<0.05); voiding dysfunction, erectile dysfunction and ejaculatory dysfunction occurred in traditional operation group, TME group, and PANP+TME group The rate gradually decreased, and there was a significant difference between the three groups (P<0.05). The PANP classification was positively correlated with dysuria, erectile dysfunction and ejaculatory dysfunction (P<0.05). Conclusions TME can reduce the local recurrence rate of rectal cancer, reduce the incidence of urinary dysfunction and sexual dysfunction. The combination of PANP and TME can further reduce the incidence of urination disorders and sexual dysfunction. The more complete the nerve preservation in PANP surgery, the urinary dysfunction after surgery. The lower the incidence of sexual dysfunction.