本文選題：直腸癌根治術(shù)　切入點：腹腔鏡　出處：《西南醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本研究對無盆壁侵犯及無盆壁淋巴結(jié)轉(zhuǎn)移的腹腔鏡直腸癌根治(PANP)術(shù)中嚴(yán)格的尋蹤神經(jīng)叢手術(shù),與非嚴(yán)格尋蹤神經(jīng)叢手術(shù)進(jìn)行對比,比較兩組完成標(biāo)準(zhǔn)TME情況、淋巴結(jié)清掃情況、自主神經(jīng)叢的損傷情況以及術(shù)后性功能障礙與排尿功能障礙發(fā)生情況。探討腹腔鏡直腸癌根治術(shù)在TME基礎(chǔ)上嚴(yán)格尋蹤自主神經(jīng)叢進(jìn)行手術(shù)的價值,從而闡明尋蹤自主神經(jīng)叢并沿其徑路直視下進(jìn)行解剖操作的重要性和意義。方法:本研究采用前瞻性隊列研究,對我院胃腸外科2013年9月~2015年9月間收治入院的無盆壁侵犯及無盆壁淋巴結(jié)轉(zhuǎn)移的中低位男性直腸癌患者,隨機(jī)將分為“嚴(yán)格尋蹤神經(jīng)叢手術(shù)組”(實驗組)與“非嚴(yán)格尋蹤神經(jīng)叢手術(shù)組”(對照組),最終符合條件的患者共計99例,其中實驗組53例,對照組46例。手術(shù)前對“嚴(yán)格尋蹤神經(jīng)叢手術(shù)組”及“非嚴(yán)格尋蹤神經(jīng)叢手術(shù)組”患者均進(jìn)行簡明性功能問卷(BSFI)以及勃起功能國際問卷(IIEF-5)調(diào)查,以確保術(shù)前兩組患者的性功能及排尿功能之間無明顯差異(P0.05)。同時術(shù)前通過統(tǒng)計分析比較兩組患者平均年齡、腫瘤大小、腫瘤的病理學(xué)類型、腫瘤的Dukes分期,以確保兩組患者無明顯差異(P0.05),具有可比性。將實驗組及對照組患者手術(shù)時間、術(shù)中出血量、術(shù)后住院時間以及術(shù)后并發(fā)癥的發(fā)生率(吻合口瘺、吻合口出血、吻合口狹窄、切口感染、肺部感染、粘連性腸梗阻)、完成標(biāo)準(zhǔn)的TME情況、術(shù)中淋巴結(jié)清掃情況、術(shù)中神經(jīng)叢的損傷情況以及術(shù)后性功能障礙與排尿功能障礙發(fā)生率、1年無瘤生存率以及術(shù)后1年生存率情況等進(jìn)行對比。統(tǒng)計學(xué)方法:本研究所得數(shù)據(jù)均采用SPSS17.0軟件及Excel2003軟件進(jìn)行統(tǒng)計分析以及數(shù)據(jù)運算。根據(jù)數(shù)據(jù)類型選擇合理的統(tǒng)計學(xué)方法,檢驗水平α值取0.05。結(jié)果:實驗組與對照組術(shù)中切除腸管長度、術(shù)后住院時間以及術(shù)后并發(fā)癥發(fā)生率差異無統(tǒng)計學(xué)意義(P0.05)。實驗組術(shù)中出血量少于對照組,兩組之間的差異有統(tǒng)計學(xué)意義(P0.05);實驗組標(biāo)準(zhǔn)TME完成率及術(shù)中淋巴結(jié)清掃的數(shù)目均高于對照組,兩組之間的差異有統(tǒng)計學(xué)意義(P0.05)。實驗組術(shù)后排尿功能及性功能障礙發(fā)生率明顯低于對照組,兩組之間的差異有統(tǒng)計學(xué)意義(P0.05)。實驗組手術(shù)時間略長于對照組,兩組之間的差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:本研究發(fā)現(xiàn)腹腔鏡直腸癌根治(PANP)術(shù)中對自主神經(jīng)叢進(jìn)行嚴(yán)格的尋蹤神經(jīng)叢徑路手術(shù),提高了直腸癌標(biāo)準(zhǔn)TME完成率,獲得了更徹底淋巴結(jié)清掃,減少了盆自主神經(jīng)叢的損傷幾率從而更好的保護(hù)患者排尿功能以及性功能。同時嚴(yán)格尋蹤神經(jīng)叢手術(shù)組并沒有增加直腸癌患者術(shù)后其他方面的并發(fā)癥發(fā)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 偽 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.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.37

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