目的：探讨以盆腔自主神经为解剖标志寻找安全的手术操作平面，进行腹腔镜下直肠癌的直肠系膜全切除（TME）的临床效果。方法：回顾性分析2010年1月—2015年12月腹腔镜低位直肠癌切除术157例男性患者的临床资料及手术视频，将2012年后的81例患者作为观察组，该组患者术中以盆腔自主神经为解剖标志行TME，从中间入路进行解剖游离，采用双吻合器技术进行消化道重建，将2012年前未按以上解剖标志手术的76例作为对照组，比较两组手术相关指标以及对患者术后泌尿和性功能情况。结果：与对照组比较，观察组术中出血量明显减少（14.9 mL vs. 26.5 mL）、手术质量3级率明显增加（89.2% vs. 59.6%），淋巴结清扫数目明显增加（19枚 vs. 15枚），术后勃起功能障碍率明显降低（2.3% vs. 4.5%，P<0.05），尿潴留率明显降低（6.2% vs. 10.5%）差异均有统计学意义（均P<0.05）。结论：TME中以盆腔自主神经为解剖标志可以最大程度完整切除直肠系膜的同时减少对盆腔内脏神经的损伤，而且对低位直肠癌TME手术的标准化和熟练掌握有帮助。
Laparoscopic total mesorectal excision for rectal cancer using pelvic autonomic nerves as anatomical landmarks
Objective: To investigate the clinical effect of using pelvic autonomic nerves as anatomical landmarks to plot a safe surgical plane for performing laparoscopic total mesorectal excision (TME). Methods: The clinical data and operation videos of 157 male patients who underwent laparoscopic low rectal resection between January 2010 and December 2015 were retrospectively analyzed. Of the patients, 81 cases treated after 2012 were categorized as observation group, who underwent TME using pelvic autonomic nerves as landmarks which were dissected and freed through medial approach, and digestive tract reconstruction by double-stapling technique; 76 cases treated before 2012 served as control group who underwent surgery without using the above anatomical landmarks. The relevant surgical variables as well as postoperative urinary and sexual function between the two groups were compared. Results: In observation group compared with control group, the intraoperative blood loss was significantly reduced (14.9 mL vs. 26.5 mL), the rate of level-3 operation quality was significantly elevated (89.2% vs. 59.6%), the number of resected lymph nodes was significantly increased (19 vs. 15), and the incidence of postoperative erectile dysfunction (2.3% vs. 4.5%) and urinary retention (6.2% vs. 10.5%) were significantly decreased, all the differences had statistical significance (all P<0.05). Conclusion: Using pelvic autonomic nerves as anatomical landmarks for TME can achieve maximally complete mesorectal resection and meanwhile reduce pelvic splanchnic nerves injuries. In addition, it may help to standardize and improve the technique of laparoscopic TME in low rectal cancer surgery.