寻踪自主神经丛在腹腔镜直肠癌根治（PANP）术中的价值

发布时间：2018-04-04 01:18

本文选题：直肠癌根治术　切入点：腹腔镜　出处：《西南医科大学》2017年硕士论文

【摘要】：目的:本研究对无盆壁侵犯及无盆壁淋巴结转移的腹腔镜直肠癌根治(PANP)术中严格的寻踪神经丛手术,与非严格寻踪神经丛手术进行对比,比较两组完成标准TME情况、淋巴结清扫情况、自主神经丛的损伤情况以及术后性功能障碍与排尿功能障碍发生情况。探讨腹腔镜直肠癌根治术在TME基础上严格寻踪自主神经丛进行手术的价值,从而阐明寻踪自主神经丛并沿其径路直视下进行解剖操作的重要性和意义。方法:本研究采用前瞻性队列研究,对我院胃肠外科2013年9月~2015年9月间收治入院的无盆壁侵犯及无盆壁淋巴结转移的中低位男性直肠癌患者,随机将分为“严格寻踪神经丛手术组”(实验组)与“非严格寻踪神经丛手术组”(对照组),最终符合条件的患者共计99例,其中实验组53例,对照组46例。手术前对“严格寻踪神经丛手术组”及“非严格寻踪神经丛手术组”患者均进行简明性功能问卷(BSFI)以及勃起功能国际问卷(IIEF-5)调查,以确保术前两组患者的性功能及排尿功能之间无明显差异(P0.05)。同时术前通过统计分析比较两组患者平均年龄、肿瘤大小、肿瘤的病理学类型、肿瘤的Dukes分期,以确保两组患者无明显差异(P0.05),具有可比性。将实验组及对照组患者手术时间、术中出血量、术后住院时间以及术后并发症的发生率(吻合口瘘、吻合口出血、吻合口狭窄、切口感染、肺部感染、粘连性肠梗阻)、完成标准的TME情况、术中淋巴结清扫情况、术中神经丛的损伤情况以及术后性功能障碍与排尿功能障碍发生率、1年无瘤生存率以及术后1年生存率情况等进行对比。统计学方法:本研究所得数据均采用SPSS17.0软件及Excel2003软件进行统计分析以及数据运算。根据数据类型选择合理的统计学方法,检验水平α值取0.05。结果:实验组与对照组术中切除肠管长度、术后住院时间以及术后并发症发生率差异无统计学意义(P0.05)。实验组术中出血量少于对照组,两组之间的差异有统计学意义(P0.05);实验组标准TME完成率及术中淋巴结清扫的数目均高于对照组,两组之间的差异有统计学意义(P0.05)。实验组术后排尿功能及性功能障碍发生率明显低于对照组,两组之间的差异有统计学意义(P0.05)。实验组手术时间略长于对照组,两组之间的差异有统计学意义(P0.05)。结论:本研究发现腹腔镜直肠癌根治(PANP)术中对自主神经丛进行严格的寻踪神经丛径路手术,提高了直肠癌标准TME完成率,获得了更彻底淋巴结清扫,减少了盆自主神经丛的损伤几率从而更好的保护患者排尿功能以及性功能。同时严格寻踪神经丛手术组并没有增加直肠癌患者术后其他方面的并发症发生率。
[Abstract]:Objective: to compare the strict tracer nerve plexus operation in laparoscopic radical resection of rectal cancer without pelvic wall invasion or pelvic wall lymph node metastasis with that of non-strict tracer plexus operation, and to compare the standard TME status between the two groups.Lymph node dissection, autonomic plexus injury, postoperative sexual dysfunction and urination dysfunction.To explore the value of laparoscopic radical resection of rectal cancer on the basis of TME, and to clarify the importance and significance of anatomic operation of autonomic plexus.Methods: a prospective cohort study was conducted in patients with middle and low rectal cancer without pelvic wall invasion or pelvic wall lymph node metastasis admitted to our hospital from September 2013 to September 2015.A total of 99 patients were randomly divided into "strict tracer plexus operation group" (experimental group) and "non-strict pursuit nerve plexus operation group" (control group), including 53 cases in experimental group and 46 cases in control group.Before operation, the patients in the "strict tracing nerve plexus operation group" and "non-strict tracing nerve plexus operation group" were investigated with a brief sexual function questionnaire (BSFI) and an international erectile function questionnaire (IIEF-5).To ensure that there was no significant difference in sexual function and urination function between the two groups before operation (P 0.05).At the same time, the mean age, tumor size, tumor pathological type and Dukes stage of the two groups were compared by statistical analysis before operation, so as to ensure that there was no significant difference between the two groups (P 0.05).The operative time, intraoperative bleeding, postoperative hospital stay and the incidence of postoperative complications (anastomotic fistula, anastomotic bleeding, anastomotic stricture, wound infection, pulmonary infection) in the experimental group and the control group were analyzed.Adhesive intestinal obstruction, complete standard TME, intraoperative lymph node dissection,The incidence of postoperative sexual dysfunction and urination dysfunction, 1 year tumor-free survival rate and 1 year survival rate were compared.Statistical method: the data were analyzed by SPSS17.0 software and Excel2003 software.Select reasonable statistical method according to data type, test level 伪 value is 0. 05.Results: there was no significant difference between the experimental group and the control group in the length of intestinal duct, the length of postoperative hospitalization and the incidence of postoperative complications (P 0.05).The amount of intraoperative bleeding in the experimental group was less than that in the control group, and the difference between the two groups was statistically significant (P 0.05), and the completion rate of standard TME and the number of lymph node dissection in the experimental group were higher than those in the control group, and the difference between the two groups was statistically significant.The incidence of urination and sexual dysfunction in the experimental group was significantly lower than that in the control group, and the difference between the two groups was statistically significant (P 0.05).The operation time in the experimental group was slightly longer than that in the control group, and the difference between the two groups was statistically significant (P 0.05).Conclusion: in this study, we found that the strict tracer nerve plexus approach was performed during laparoscopic radical resection of rectal cancer, which improved the standard TME completion rate of rectal cancer and obtained more complete lymph node dissection.Reduces the pelvic autonomic plexus injury probability, thus better protects the patient urination function and the sexual function.At the same time, strict tracer plexus surgery group did not increase the incidence of other postoperative complications in rectal cancer patients.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.37

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