目的 观察腹腔镜下保留盆腔自主神经(PANP)的全直肠系膜切除术对直肠癌患者的临床疗效。方法 纳入罗定市人民医院2012年2月—2015年6月期间收治的直肠癌行PANP的全直肠系膜切除术治疗患者82例,按速记排列表法分为开腹组和腹腔镜组两组,每组各41例。其中,开腹组行保留盆腔自主神经的开腹全直肠系膜切除术(OTME),腹腔镜组行保留盆腔自主神经的腹腔镜下全直肠系膜切除术(LTME),观察两组手术情况、并发症及1年期生存率。结果 腹腔镜组手术时间、出血量、胃肠功能恢复时间、下床活动时间及住院时间均优于开腹组(P＜0.05),并发症发生率明显低于开腹组(7.32% 对21.95%,P＜0.05),肿瘤1年期复发率(0%)和患者1年期生存率(100%)与开腹组(2.44%和100%)无显著差异。结论 保护盆腔自主神经的腹腔镜下全直肠系膜切除术治疗直肠癌疗效较好,术后并发症少,胃肠功能恢复快,值得临床推广。

Objective To observe the clinical effect of laparoscopic total mesorectal excision (LTME) with pelvic automatic nerve preservation (PANP) on patients with rectal cancer.Methods A total of 82 patients with rectal cancer were selected from February 2012 to June 2015 in Luoding People’s Hospital.Of them,41 cases received open total mesorectal excision and PANP (OTME+PANP group),and the other 41 cases received LTME and PANP (LTME+PANP group).The operation condition,complication incidence,and survival rate within one year of each group were observed.Results The operation time,bleeding volume,recovery time of gastrointestinal function,time of leaving bed,and hospitalization time of the LTME+PANP group was significantly better than those of the OTME+PANP group (P<0.05); the incidence rate of complications of the LTME+PANP group was significantly lower than that of the OTME+PANP group (7.32% vs.21.95%,P<0.05); the recurrence rate (0%) and the survival rate (100%) within one year of the LTME+PANP group were not statistically different from those of the OTME+PANP group (2.44% and 100%) (P<0.05).Conclusion The combination of LTME and PANP has a better treatment effect for patients with rectal cancer,resulting in decreased postoperative complication incidence and faster recovery of gastrointestinal function,thus the surgery is worthy of clinical application.