基于TME技术的直肠癌根治术中保留植物神经的临床体会(1)
[摘要] 目的：讨论基于全直肠系膜切除(TME)的直肠癌保留植物神经根治术对男性局部复发率、生存率和术后生活质量的影响。方法：回顾性分析193例应用TME技术的直肠癌根治术的临床资料，其中保留植物神经根治术128例与传统直肠癌根治术(未保留)65例，比较两组患者的局部复发率、5年生存率及术后排尿功能和性功能。结果：两组均顺利完成手术，其中保留植物神经组105例获得随访，传统手术组53例获得随访。局部复发率保留植物神经组为8.57%(9/105)，传统术式组为11.32%(6/53)；5年生存率保留植物神经组为62.86%(66/105)，传统术式组为52.83%(28/53)，两组比较差异无统计学意义(P>0.05)。排尿功能障碍保留植物神经组为29.52%(31/105)，传统术式组为66.04%(35/53)；勃起功能障碍保留植物神经组为22.86%(24/105)，传统术式组为69.81%(37/53)；射精功能障碍保留植物神经组29.52%(31/105)，传统术式组73.58%(39/53)，两组比较差异有统计学意义(P<0.05)。结论：TME保留植物神经的直肠癌根治术在不增加局部复发率和不降低5年生存率的同时，可以减少患者排尿功能和性功能障碍的发生，提高患者术后的生存质量。
, http://www.100md.com
[关键词] 全直肠系膜切除术；直肠癌；保留植物神经
[中图分类号] R735.3+7[文献标识码] B [文章编号] 1673-7210(2011)07(b)-090-03
The clinical analysis on total mesorectal excision with autonomic nerve preservation in rectal cancer
LIANG Tianwei, LU Yonggang, MO Chunlian, WEI Yilun, SUN Yi
Department of General Surgery, the Affiliated Liuzhou Hospital of Southern Medical University, Liuzhou 545007, China
, 百拇医药
[Abstract] Objective: To consider the relationship to rate of local recurrence, rate of survival and quality of life underwent total mesorectal excision with autonomic nerve preservation in rectal cancer. Methods: By contrasted, a retrospective evaluation of TME-ANP surgery or radical operation without ANP on rate of local recurrence, a rate of 5-year survival and urinary function and sexual function were performed. TME-ANP surgery and conventional radical operation were performed on 128 cases and 65 cases were rectal cancers respectively. Results: All of the cases were completed successfully. The rate of local recurrence, the TME-ANP group was 8.57%(9/105)，and the conventional radical operation group was 11.32% (6/53), P>0.05. For the rate of 5-year survival, the TME-ANP group was 62.86%(66/105), and the conventional radical operation group was 52.83%(28/53), P>0.05. For the injured urinary function, the group of TME-ANP was 29.52% (31/105), and the conventional radical operation group was 66.04%(35/53), P<0.05. For the erectile dysfunction, the group of TME-ANP was 22.86%(24/105), and the conventional radical operation group was 69.81%(37/53), P<0.05. For the ejaculatory disorder, the group of TME-ANP was 29.52%(31/105), and the conventional radical operation group was 73.58% (39/53), P<0.05. Conclusion: The total mesorectal excision with autonomic nerve preserwation in rectal cancer are associated with insignificantly higher rate of local recurrence, a insignificantly lower rate of 5-year survival, a better life quality.
, 百拇医药
[Key words] Total mesorectal excision; Rectal cancer; Autonomic nerve preservation
直肠癌是我国常见的恶性肿瘤之一，手术为其最主要的治疗方法。性功能障碍和排尿功能障碍是传统根治术后常见并发症，严重影响患者的生活质量。随着1982年Heald等[1]提出全直肠系膜切除术(total mesorectal excision，TME)的理论及近年来国内外学者提出保留盆腔植物神经(pelvic autonomic nerve)的手术理念的应用，我院2003年6月～2010年6月遵循TME及PANP原则对128例直肠癌患者进行了保留盆腔植物神经的直肠癌根治术，现报道如下：
1 资料与方法
1.1 一般资料
回顾性分析2003年6月～2010年6月在我院手术的193例直肠癌男性患者的临床资料，保留植物神经组(A组)和传统术式组(B组)。A组128例，年龄25～65岁，中位年龄51.5岁；Dukes A期45例，B期52例，C期31例；其中高分化腺癌46例，中分化腺癌63例，低分化腺癌12例，黏液腺癌5例，印戒细胞癌2例。B组65例，年龄28～67岁，中位年龄53.8岁；DukesA期22例，B期26例，C期17例；其中高分化腺癌23例，中分化腺癌27例，低分化腺癌7例，黏液腺癌6例，印戒细胞癌2例。两组患者术前均确定性功能及排尿功能正常。, http://www.100md.com(梁天伟 卢永刚 莫春连 韦义伦 孙 轶)
, http://www.100md.com
[关键词] 全直肠系膜切除术；直肠癌；保留植物神经
[中图分类号] R735.3+7[文献标识码] B [文章编号] 1673-7210(2011)07(b)-090-03
The clinical analysis on total mesorectal excision with autonomic nerve preservation in rectal cancer
LIANG Tianwei, LU Yonggang, MO Chunlian, WEI Yilun, SUN Yi
Department of General Surgery, the Affiliated Liuzhou Hospital of Southern Medical University, Liuzhou 545007, China
, 百拇医药
[Abstract] Objective: To consider the relationship to rate of local recurrence, rate of survival and quality of life underwent total mesorectal excision with autonomic nerve preservation in rectal cancer. Methods: By contrasted, a retrospective evaluation of TME-ANP surgery or radical operation without ANP on rate of local recurrence, a rate of 5-year survival and urinary function and sexual function were performed. TME-ANP surgery and conventional radical operation were performed on 128 cases and 65 cases were rectal cancers respectively. Results: All of the cases were completed successfully. The rate of local recurrence, the TME-ANP group was 8.57%(9/105)，and the conventional radical operation group was 11.32% (6/53), P>0.05. For the rate of 5-year survival, the TME-ANP group was 62.86%(66/105), and the conventional radical operation group was 52.83%(28/53), P>0.05. For the injured urinary function, the group of TME-ANP was 29.52% (31/105), and the conventional radical operation group was 66.04%(35/53), P<0.05. For the erectile dysfunction, the group of TME-ANP was 22.86%(24/105), and the conventional radical operation group was 69.81%(37/53), P<0.05. For the ejaculatory disorder, the group of TME-ANP was 29.52%(31/105), and the conventional radical operation group was 73.58% (39/53), P<0.05. Conclusion: The total mesorectal excision with autonomic nerve preserwation in rectal cancer are associated with insignificantly higher rate of local recurrence, a insignificantly lower rate of 5-year survival, a better life quality.
, 百拇医药
[Key words] Total mesorectal excision; Rectal cancer; Autonomic nerve preservation
直肠癌是我国常见的恶性肿瘤之一，手术为其最主要的治疗方法。性功能障碍和排尿功能障碍是传统根治术后常见并发症，严重影响患者的生活质量。随着1982年Heald等[1]提出全直肠系膜切除术(total mesorectal excision，TME)的理论及近年来国内外学者提出保留盆腔植物神经(pelvic autonomic nerve)的手术理念的应用，我院2003年6月～2010年6月遵循TME及PANP原则对128例直肠癌患者进行了保留盆腔植物神经的直肠癌根治术，现报道如下：
1 资料与方法
1.1 一般资料
回顾性分析2003年6月～2010年6月在我院手术的193例直肠癌男性患者的临床资料，保留植物神经组(A组)和传统术式组(B组)。A组128例，年龄25～65岁，中位年龄51.5岁；Dukes A期45例，B期52例，C期31例；其中高分化腺癌46例，中分化腺癌63例，低分化腺癌12例，黏液腺癌5例，印戒细胞癌2例。B组65例，年龄28～67岁，中位年龄53.8岁；DukesA期22例，B期26例，C期17例；其中高分化腺癌23例，中分化腺癌27例，低分化腺癌7例，黏液腺癌6例，印戒细胞癌2例。两组患者术前均确定性功能及排尿功能正常。, http://www.100md.com(梁天伟 卢永刚 莫春连 韦义伦 孙 轶)