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目的:探讨以盆腔自主神经为解剖标志寻找安全的手术操作平面,进行腹腔镜下直肠癌的直肠系膜全切除(TME)的临床效果。方法:回顾性分析2010年1月—2015年12月腹腔镜低位直肠癌切除术157例男性患者的临床资料及手术视频,将2012年后的81例患者作为观察组,该组患者术中以盆腔自主神经为解剖标志行TME,从中间入路进行解剖游离,采用双吻合器技术进行消化道重建,将2012年前未按以上解剖标志手术的76例作为对照组,比较两组手术相关指标以及对患者术后泌尿和性功能情况。结果:与对照组比较,观察组术中出血量明显减少(14.9 mL vs.26.5 mL)、手术质量3级率明显增加(89.2%vs.59.6%),淋巴结清扫数目明显增加(19枚vs.15枚),术后勃起功能障碍率明显降低(2.3%vs.4.5%,P<0.05),尿潴留率明显降低(6.2%vs.10.5%)差异均有统计学意义(均P<0.05)。结论:TME中以盆腔自主神经为解剖标志可以最大程度完整切除直肠系膜的同时减少对盆腔内脏神经的损伤,而且对低位直肠癌TME手术的标准化和熟练掌握有帮助。
Objective: To explore the clinical efficacy of pelvic autonomic nerve as an anatomical landmark in the search for a safe surgical operation plane for total mesorectal excision (TME) of laparoscopic rectal cancer. Methods: The clinical data and surgical video of 157 male patients undergoing laparoscopic low rectal cancer resection from January 2010 to December 2015 were retrospectively analyzed. Eighty-one patients after 2012 were selected as the observation group. The patients in the operation group Pelvic autonomic nerve was antegrade TME, dissected from the middle of the road, double stapling technique was used to reconstruct the digestive tract, 76 cases without anatomical landmark operation before 2012 were taken as the control group, and the operation related indexes As well as the patient’s postoperative urinary and sexual function. Results: Compared with the control group, the blood loss in observation group decreased significantly (14.9 mL vs. 26.5 mL), the grade 3 of operation quality was significantly increased (89.2% vs 59.6%), the number of lymph node dissection was significantly increased (19 vs. 15), postoperative erectile dysfunction rate was significantly lower (2.3% vs.4.5%, P <0.05), urinary retention rate was significantly lower (6.2% vs.10.5%) were statistically significant differences (all P <0.05) . Conclusion: The TME is an anatomical landmark of pelvic autonomic nerve that can completely remove the mesorectum and reduce the damage to the visceral nerves in pelvic cavity. It is also helpful for the standardization and mastery of TME for low rectal cancer.