目的

比较不同导向解剖入路腹腔镜根治术治疗早期直肠癌的临床效果。

方法

回顾性分析2021年1月至2023年12月行腹腔镜直肠癌根治术的101例早期直肠癌患者资料，依据手术选择的解剖入路不同，将53例以自主神经导向行腹腔镜直肠癌根治术的患者纳入神经导向组，将48例以血管导向行腹腔镜直肠癌根治术的患者纳入血管导向组。采用SPSS 25.0统计软件分析数据，围手术期相关指标、胃肠激素指标以（）表示，行独立样本t检验；排尿功能障碍发生情况行χ²检验，排尿功能分级采用秩和检验。P<0.05表示差异有统计学意义。

结果

神经导向组患者术中出血量少于血管导向组、首次排气时间短于血管导向组（P<0.05）；两组患者手术时间、淋巴结清扫数目、住院时间比较无显著差异（P>0.05）。术后2d，两组患者血清血清胃泌素（GAS）、胃动素（MOT）均较术前降低，但神经导向组血清GAS、MOT水平高于血管导向组（P<0.05）。术后7d，神经导向组排尿功能分级优于血管导向组，术后排尿功能障碍发生率（18.7%）低于血管导向组（39.6%）（P<0.05）。

结论

以自主神经导向及血管导向行腹腔镜根治术治疗早期直肠癌均有较好的临床效果，但前者术中出血量少，患者术后肠道功能恢复快，可减少术后排尿功能障碍发生。

Objective

To compare the clinical efficacy of laparoscopic radical surgery with different guided anatomical approaches in the treatment of early rectal cancer.

Methods

A retrospective analysis was conducted on 101 patients with early rectal cancer who underwent surgical treatment and follow-up at the hospital from January 2021 to December 2023. The patients underwent laparoscopic radical rectal cancer surgery. According to the different anatomical approaches chosen for surgery, 53 patients who underwent laparoscopic rectal cancer radical surgery under autonomous nerve guidance were included in the nerve guided group, while the remaining 48 patients who underwent laparoscopic rectal cancer radical surgery under vascular guidance were included in the vascular guided group. SPSS 25.0 statistical software was used to analyze the data. Perioperative related indicators and gastrointestinal hormone indicators were expressed as (), and independent sample t tests were performed. The occurrence of urinary dysfunction was analyzed using χ² test, and the grading of urinary function was performed using a Rank Sum test. P<0.05 indicated a statistical significant difference.

Results

The intraoperative bleeding volume in the nerve guided group was less than that in the vascular guided group, and the first exhaust time was shorter than that in the vascular guided group,with statistical significant differences (P<0.05). There was no statistical significant difference in surgical time,lymph node dissection count, and hospital stay between the two groups (P>0.05). On the 2nd day after surgery,the serum GAS and MOT levels in both groups decreased compared to before surgery, but the serum GAS and MOT levels in the nerve guided group were higher than those in the vascular guided group, with statistical significant differences (P<0.05). At 7 days after surgery, the urinary function grading of the nerve guided group was better than that of the vascular guided group, and the incidence of postoperative urinary dysfunction (18.7%)was lower than that of the vascular guided group (39.6%), with statistical significant differences (P<0.05).

Conclusion

Both autonomous nerve guided and vascular guided laparoscopic radical surgery have good clinical effects in the treatment of early rectal cancer. However, the former has less intraoperative bleeding,faster postoperative intestinal function recovery, and can reduce postoperative urinary dysfunction.