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中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 639 -642. doi: 10.3877/cma.j.issn.1674-3946.2021.06.015

论著

腹腔镜低位直肠癌根治术中保留与不保留Denonvilliers筋膜的对照研究
李庆1, 高波1,(), 侯花屏1, 王键1   
  1. 1. 719000 陕西榆林,榆林市第一医院普通外科
  • 收稿日期:2020-12-09 出版日期:2021-12-26
  • 通信作者: 高波

A comparative study of Denonvilliers fascia retention or not in the laparoscopic radical resection of low rectal cancer

Qing Li1, Bo Gao1,(), Huaping Hou1, Jian Wang1   

  1. 1. Department of General Surgery, Yulin First Hospital, Shanxi 719000, China
  • Received:2020-12-09 Published:2021-12-26
  • Corresponding author: Bo Gao
  • Supported by:
    The Key R & D Projects of Shanxi Province(2018SF-067); The Health and Family Planning Research Project of Shanxi Province(2016D119)
引用本文:

李庆, 高波, 侯花屏, 王键. 腹腔镜低位直肠癌根治术中保留与不保留Denonvilliers筋膜的对照研究[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(06): 639-642.

Qing Li, Bo Gao, Huaping Hou, Jian Wang. A comparative study of Denonvilliers fascia retention or not in the laparoscopic radical resection of low rectal cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(06): 639-642.

目的

探讨腹腔镜低位直肠癌根治术中保留与不保留Denonvilliers筋膜(DVF)对男性患者的术后排尿功能、性功能等的影响。

方法

选取2018年3月至2020年3月行腹腔镜下低位直肠癌根治术的108例男性患者为研究对象,随机分为两组,每组54例,一组术中切除DVF筋膜(切除组),另一组保留DVF筋膜(保留组)。采用软件SPSS19.0进行统计学分析。围术期指标、尿动力学指标等以均数±标准差(±s)表示,采用独立t检验;并发症等计数资料采用χ2检验分析;排尿功能分级、性功能分级等级资料采用非参数秩和检验分析;以P<0.05表示差异有统计学意义。

结果

保留组手术时间明显长于切除组,术中出血量、术中输血例数均少于切除组(P<0.05);保留组患者的最大尿流量、最大逼尿肌收缩压、最大尿道压、膀胱顺应性等均明显大于切除组(P>0.05);保留组排尿功能和射精功能障碍、勃起功能障碍均优于保留组(P<0.05);两组患者并发症发生率差异无统计学意义(P>0.05)。

结论

男性低位直肠癌患者行腹腔镜下直肠癌根治术中保留DVF筋膜可明显减少术中出血、输血例数,同时显著改善患者术后尿动力学、排尿功能、性功能,安全有效。

Objective

To investigate the impact of retaining or not retaining the Denonvilliers fascia (DVF) on the urinary and sexual function of male patients after laparoscopic radical resection of low rectal cancer.

Methods

The clinical data of 108 male patients who underwent laparoscopic radical resection of low rectal cancer from March 2018 to March 2020 were analyzed retrospectively. and who were randomly divided into the resection group(n=54 cases), and the retention group (n=54 cases), according to the preservation of DVF or not. Statistical analysis were performed by using SPSS19.0 software. The perioperative indexes such as operation time, intraoperative blood loss, length of bowel resection, number of lymph node dissection were expressed as (±s), the difference between groups were examined by using T test., The complications were examined by using χ2 test , and the grade of urination and sexual function were analyzed by using nonparametric rank sum test, A P value of <0.05 was considered as statistically significant difference.

Results

The operation time in the retention group was significantly longer than that in the resection group, and the amount of blood loss and intraoperative transfusion were less than those in the resection group respectively(P<0.05). However, there was no significant difference between two groups in terms of the length of resected bowel specimens and the number of harvested lymph nodes (P>0.05). The maximum urine flow, maximum detrusor systolic pressure, maximum urethral pressure and bladder in the retention group were much lower than those in the resection group respectively (P<0.05). The cysts compliance was significantly higher than that in the resection group; the incidence of voiding dysfunction, ejaculation dysfunction and erectile dysfunction were lower than those in the resection group.(P<0.05) There was no significantly difference between the two groups in terms of the incidence of pelvic abscess, anal pain, intestinal obstruction (P>0.05).

Conclusion

For male patients with low rectal cancer underwent laparoscopic radical resection, retaining the Denonvilliers fascia could significantly reduce blood loss and transfusion, with improved postoperative indexes, urination function, and sexual function, which is safe and effective.

表1 108例腹腔镜低位直肠癌根治术中DVF不同处理方式两组患者基本临床资料比较(±s)
表2 108例腹腔镜低位直肠癌根治术中DVF不同处理方式两组患者围术期相关指标比较(±s)
表3 108例腹腔镜低位直肠癌根治术中DVF不同处理方式两组患者术后尿动力学相关指标比较[(±s), cmH2O]
表4 108例腹腔镜低位直肠癌根治术中DVF不同处理方式两组患者术后排尿功能比较[例(%)]
表5 108例腹腔镜低位直肠癌根治术中DVF不同处理方式两组患者术后性功能比较(例)
表6 108例腹腔镜低位直肠癌根治术中DVF不同处理方式两组患者术后并发症比较[例(%)]
[1]
Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. Ca-Cancer J Clin, 2018, 68(6) : 394-424.
[2]
胡俊君,李社方,夏春明. 中低位直肠癌TME手术结合侧方淋巴结清扫的临床意义研究[J/CD]. 中华普外科手术学杂志(电子版)202115(1):39-42.
[3]
Bjoern MX, Nielsen S, Perdawood SK. Quality of Life After Surgery for Rectal Cancer: a Comparison of Functional Outcomes After Transanal and Laparoscopic Approaches[J]. J Gastrointest Surg, 2019, 23(8) : 1623-1630.
[4]
方佳峰,卫洪波. 直肠癌根治术中是否切除Denonvilliers筋膜的争议与展望[J]. 中国实用外科杂志201838(10):1124-1127.
[5]
Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery -the clue to pelvic recurrence? [J]. Br J Surg, 1982, 69(10) : 613-616.
[6]
Perdawood SK, Thinggaard BS, Bjoern MX. Effect of transanal total mesorectal excision for rectal cancer: comparison of short-term outcomes with laparoscopic and open surgeries[J]. Surg Endosc, 2018, 32(5) : 2312-2321.
[7]
Helbach MV, Koedam TWA, Knol JJ, et al. Quality of life after rectal cancer surgery: differences between laparoscopic and transanal total mesorectal excision[J]. Surg Endosc, 2019, 33(1) : 79-87.
[8]
Persiani R, Biondi A, Pennestri F, et al. Transanal total mesorectal excision vs laparoscopic total mesorectal excision in the treatment of low and middle rectal cancer: a propensity score matching analysis[J]. Dis Colon Rectum, 2018, 61(7) : 809-816.
[9]
Chapuis P, Zhang M, Bokey L. Use the Peritoneal Reflection to Identify the Correct Avascular Plane Posterior to Denonvilliers’ Fascia[J]. Clin Anat, 2020, 33(4) : 477-478.
[10]
池畔,王枭杰. 机器人和腹腔镜全直肠系膜切除术中Denonvilliers筋膜解剖的意义及技巧[J]. 中国实用外科杂志201737(6):609-615.
[11]
Walz J, Epstein JI, Ganzer R, et al. A Critical Analysis of the Current Knowledge of Surgical Anatomy of the Prostate Related to Optimisation of Cancer Control and Preservation of Continence and Erection in Candidates for Radical Prostatectomy: An Update[J]. Eur Urol, 2016, 70(2) : 301-311.
[12]
汲崇亮,贾秋梅,张威. 腹腔镜直肠癌根治术中保留Denonvilliers筋膜对男性性功能的影响研究[J]. 中国性科学201726(12):15-18.
[13]
Fang JF, Zheng ZH, Wei HB. Reconsideration of the Anterior Surgical Plane of Total Mesorectal Excision for Rectal Cancer[J]. Dis Colon Rectum, 2019, 62(5) : 639-641.
[14]
Liu JP, Huang PJ, Liang Q, et al. Preservation of Denonvilliers’ fascia for nerve-sparing laparoscopic total mesorectal excision: A neuro-histological study[J]. Clin Anat, 2019, 32(3) : 439-445.
[15]
Wei B, Zheng ZH, Fang JF, et al. Effect of Denonvilliers’ Fascia Preservation Versus Resection During Laparoscopic Total Mesorectal Excision on Postoperative Urogenital Function of Male Rectal Cancer Patients: Initial Results of Chinese PUF-01 Randomized Clinical Trial[J]. Ann Surg, 2020, 23(8) : 532-538.
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