开腹与腹腔镜下保留盆腔自主神经根治术治疗男性低位直肠癌的临床研究
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摘要
目的探讨开腹与腹腔镜下保留盆腔自主神经根治术治疗男性低位直肠癌的效果。方法纳入80例男性低位直肠癌患者作为研究对象,其中以2012年4月至2013年4月40例接受开腹保留盆腔自主神经根治术(O-PANP)的患者为对照组,2013年5月至2014年5月40例接受L-PANP的患者为观察组。比较两组手术基本情况,术后性功能和排尿功能恢复情况及术后3年生存情况。结果观察组术中出血量、术后肛门首次排气时间、进流质饮食时间、首次下床活动时间及住院时间均少于对照组(均P<0.05),两组手术时间和淋巴结清扫数目差异均无统计学意义(均P>0.05)。两组3年总生存率差异无统计学意义(P>0.05),观察组3年无事件生存率高于对照组(P<0.05)。术后半年,观察组勃起、射精功能优于对照组,差异均有统计学意义(均P<0.05);术后1年,观察组勃起功能优于对照组(P<0.05)。术后半年,观察组排尿功能优于对照组(P<0.05);术后1年和术后3年,两组排尿功能差异均无统计学意义(均P>0.05)。结论 L-PANP用于男性低位直肠癌患者较O-PANP更有利于术后康复以及术后性功能和排尿功能的早期恢复,提升术后3年无事件生存率。
Objective To investigate the effect of open and laparoscopic radical resection with pelvic autonomic nerve preservation for the treatment of low rectal cancer in men. Methods 80 men with low rectal cancer were included in this study. 40 patients who received open radical resection with pelvic autonomic nerve preservation(O-PANP) from April 2012 to April 2013 were the control group, and 40 patients who received laparoscopic radical resection with pelvic autonomic nerve preservation(L-PANP) from May 2013 to May 2014 were the treatment group. The indices related to surgery, postoperative sexual function, recovery of voiding function and 3-year survival were compared between the two groups. Results The amount of bleeding, time to first anus exhaust after operation,time to fluid intake, time to first off-bed activity, and duration of hospitalization were significantly less in the treatment group than in the control group(P < 0.05). There was no significant difference between the two groups in duration of operation and the number of lymph node dissection(P > 0.05). There was no significant difference in 3-year survival rate between the two groups(P > 0.05). The3-year event-free survival was higher in the treatment group than that in the control group(P < 0.05). After half a year, the erectile and ejaculatory function were better in the treatment group than in control group(P < 0.05). After 1 year, erectile function was better in the treatment group than in the control group(P < 0.05). After half a year, the voiding function was better in the treatment group than in the control group(P < 0.05). At 1 year and 3 years after the operation, there was no significant difference between the two groups in voiding function(P > 0.05). Conclusion In men with low rectal cancer, compared with O-PANP, L-PANP is better in postoperative recovery, as well as early recovery of postoperative sexual function and voiding function. It also increases 3-year eventfree survival.
Objective To investigate the effect of open and laparoscopic radical resection with pelvic autonomic nerve preservation for the treatment of low rectal cancer in men. Methods 80 men with low rectal cancer were included in this study. 40 patients who received open radical resection with pelvic autonomic nerve preservation(O-PANP) from April 2012 to April 2013 were the control group, and 40 patients who received laparoscopic radical resection with pelvic autonomic nerve preservation(L-PANP) from May 2013 to May 2014 were the treatment group. The indices related to surgery, postoperative sexual function, recovery of voiding function and 3-year survival were compared between the two groups. Results The amount of bleeding, time to first anus exhaust after operation,time to fluid intake, time to first off-bed activity, and duration of hospitalization were significantly less in the treatment group than in the control group(P < 0.05). There was no significant difference between the two groups in duration of operation and the number of lymph node dissection(P > 0.05). There was no significant difference in 3-year survival rate between the two groups(P > 0.05). The3-year event-free survival was higher in the treatment group than that in the control group(P < 0.05). After half a year, the erectile and ejaculatory function were better in the treatment group than in control group(P < 0.05). After 1 year, erectile function was better in the treatment group than in the control group(P < 0.05). After half a year, the voiding function was better in the treatment group than in the control group(P < 0.05). At 1 year and 3 years after the operation, there was no significant difference between the two groups in voiding function(P > 0.05). Conclusion In men with low rectal cancer, compared with O-PANP, L-PANP is better in postoperative recovery, as well as early recovery of postoperative sexual function and voiding function. It also increases 3-year eventfree survival.
引文
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[11]马晓龙,刘庆国,顾全凯,等.腹腔镜保留盆腔自主神经直肠癌根治术对排尿及性功能的影响[J].现代预防医学,2012,39(7):1855-1856.
[12]SUGIHARA K,MORIYA Y,AKASU T,et al.Pelvic autonomic nerve preservation for patients with rectal carcinoma.Oncologic and functional outcome[J].Cancer,2015,78(9):1871-1880.
[13]郑敏华,郭云萍.直肠癌手术患者性功能障碍情况及其相关影响因素调查研究[J].中国性科学,2013,22(11):9-11.
[14]田衍,罗华友.腹腔镜下低位直肠癌手术中保留盆腔自主神经的临床疗效[J].中国老年学,2013,33(2):308-309.
[2]卫洪波,郑宗珩.腹腔镜保留盆腔自主神经的直肠癌根治术技术要领[J].中华胃肠外科杂志,2015,14(6):529-532.
[3]盛建,徐青,陈锦鹏,等.保留盆腔自主神经的全直肠系膜切除术在男性直肠癌保肛术中的应用研究[J].中国癌症杂志,2010,20(9):686-690.
[4]曾志强,霍景山,陶世明.腹腔镜直肠癌全系膜切除根治术与开放手术对盆腔自主神经的影响[J].中国普通外科杂志,2013,22(6):800-802.
[5]宋明东,周活动,谢伟,等.腹腔镜全直肠系膜切除术治疗低位直肠癌的疗效观察[J].结直肠肛门外科,2014,20(2):136-138.
[6]黄美近,林金鑫,邓艳红,等.中低位直肠癌新辅助放化疗序贯手术对勃起功能影响的前瞻性随机对照研究[J].中华外科杂志,2014,52(11):822-825.
[7]丛进春,陈春生,冯勇,等.新辅助治疗对低位直肠癌经内外括约肌间切除术后肛门功能的影响[J].中国肿瘤临床,2013,40(23):1450-1454.
[8]牛坚,王月,刘斌.腹腔镜下直肠癌系膜全切除和盆腔自主神经的关系[J].安徽医科大学学报,2016,51(12):1832-1835.
[9]刘念,林谋斌,张浩波,等.全直肠系膜切除术中保留男性盆腔自主神经的解剖基础[J].国际外科学杂志,2012,39(6).387-389.
[10]ZHOU H,RUAN C,SUN Y,et al.Nerve-guided laparoscopic total mesorectal excision for distal rectal cancer[J].Annals of Surgical Oncology,2015,22(2):550.
[11]马晓龙,刘庆国,顾全凯,等.腹腔镜保留盆腔自主神经直肠癌根治术对排尿及性功能的影响[J].现代预防医学,2012,39(7):1855-1856.
[12]SUGIHARA K,MORIYA Y,AKASU T,et al.Pelvic autonomic nerve preservation for patients with rectal carcinoma.Oncologic and functional outcome[J].Cancer,2015,78(9):1871-1880.
[13]郑敏华,郭云萍.直肠癌手术患者性功能障碍情况及其相关影响因素调查研究[J].中国性科学,2013,22(11):9-11.
[14]田衍,罗华友.腹腔镜下低位直肠癌手术中保留盆腔自主神经的临床疗效[J].中国老年学,2013,33(2):308-309.