探讨神经监测技术在男性中低位直肠癌全直肠系膜切除术（TME）中辅助识别和保护盆腔自主神经（PAN）及Denonvilliers筋膜的应用价值，并重新审视相关解剖结构。

回顾性选取2021年10月至2022年12月行TME的男性中低位直肠癌患者78例为观察组（术中实施盆腔自主神经监测），纳入同期80例患者为对照组（术中实施未应用神经监测的保护盆腔自主神经）。采用SPSS 27.0软件进行数据分析，符合正态分布的计量资料以（均数±标准差）表示，组间比较采用独立样本t检验，组内不同时间点比较采用配对样本t检验；计数资料采用χ²检验。P<0.05表示差异有统计学意义。

肿瘤切除后，前列腺、精囊腺、膀胱、肛门内/外括约肌等效应器官电位变化与肿瘤切除前对比，差异无统计学意义（P>0.05）。术后6个月，两组患者国际前列腺症状评分（IPSS）高于术前，国际勃起功能问卷-5（IIEF-5）评分低于术前，且观察组IPSS评分低于对照组、IIEF-5评分高于对照组，差异有统计学意义（P<0.05），术后12个月，对照组IPSS评分仍高于术前，IIEF-5评分仍低于术前（P<0.05），但观察组上述评分与术前比较未见统计学差异（P>0.05），且观察组IPSS评分低于对照组、IIEF-5评分高于对照组（P<0.05）；两组患者术后并发症总发生率比较差异具有统计学意义（P<0.05）。

男性中低位直肠癌TME术中实施盆腔自主神经监测能够精准识别术中保留盆腔自主神经（PAN）及其分支，减少PAN损伤以确保其功能的完整性，改善患者术后泌尿生殖功能。同时，术中正确辨识Denonvilliers筋膜并掌握其解剖技巧，有助于维持正确的手术解剖层面，更好地保护PAN，从而进一步改善患者预后并促进TME手术的规范开展。

To explore the application value of neural monitoring technology in assisting the identification and protection of pelvic autonomic nerves (PAN) and Denonvilliers’ fascia during total mesorectal excision (TME) for male patients with middle and low rectal cancer, and to re-examine the relevant anatomical structures.

A retrospective study was conducted. A total of 78 male patients with middle and low rectal cancer who underwent TME from October 2021 to December 2022 were selected as the observation group (intraoperative pelvic autonomic nerve monitoring was performed). Meanwhile, 80 patients who underwent TME during the same period were included as the control group (intraoperative PAN protection was conducted without neural monitoring). SPSS 27.0 software was used for data analysis. Measurement data conforming to a normal distribution were expressed as (mean±standard deviation). Independent samples t test was used for inter-group comparison, and paired samples t test was used for comparison of data at different time points within the same group. Categorical data were analyzed using the χ² test. P<0.05 was considered statistically significant.

After tumor resection, there were no statistically significant differences in the potential changes of effector organs such as the prostate, seminal vesicles, bladder, and internal/external anal sphincters compared with those before tumor resection (P>0.05). At 6 months postoperatively, the International Prostate Symptom Score (IPSS) of patients in both groups was higher than that before surgery, and the International Index of Erectile Function-5 (IIEF-5) score was lower than that before surgery. Moreover, the IPSS score of the observation group was lower than that of the control group, and the IIEF-5 score was higher than that of the control group, with statistically significant differences (P<0.05). At 12 months postoperatively, the IPSS score of the control group was still higher than that before surgery, and the IIEF-5 score was still lower than that before surgery (P<0.05); however, there were no statistically significant differences between the above scores of the observation group and those before surgery (P>0.05). Additionally, the IPSS score of the observation group was lower than that of the control group, and the IIEF-5 score was higher than that of the control group (P<0.05). There was a statistically significant difference in the total incidence of postoperative complications between the two groups (P<0.05).

Implementing pelvic autonomic nerve monitoring during TME for male patients with middle and low rectal cancer can accurately identify and preserve PAN and their branches during surgery, reduce PAN injury to ensure the integrity of their functions, and improve patients’ postoperative urogenital function. Meanwhile, correct identification of Denonvilliers’ fascia during surgery and mastery of its anatomical techniques are helpful for maintaining the correct surgical anatomical plane, better protecting PAN, thereby further improving patients’ prognosis and promoting the standardized implementation of TME surgery.