随着腹腔镜技术的迅速发展，腹腔镜全直肠系膜切除术（TME）已成为直肠癌的标准手术。然而，低、中位直肠癌患者术后膀胱功能及性功能障碍的发生率仍较高。如何避免盆腔自主神经损伤尤为重要。与传统的二维腹腔镜手术相比，三维腹腔镜手术还原了真实的三维视野、出现了纵深感，能更清晰地显示直肠周围层，减少盆腔自主神经损伤。近两年来本中心开展了3D腹腔镜下TME手术千余例。本文将探讨三维腹腔镜手术中自主神经保护的经验和技巧，包括盆腔自主神经解剖、手术方法的选择和手术中的要点。

With the rapid development of laparoscopic technology, laparoscopic total mesorectal excision (TME) has become the standard operation for rectal cancer. However, the incidence of bladder function and sexual dysfunction is still high in patients with low and middle rectal cancer after operation. How to avoid pelvic autonomic nerve injury is particularly important. Compared with traditional 2D laparoscopic surgery, 3D laparoscopy restores the real three-dimensional visual field and presents a sense of depth, and so it can reveal the perirectal layers more clearly and then reduce pelvic autonomic nerve injury. In the past two years, our center has performed more than 1 000 cases of 3D laparoscopic TME surgery. This article will discuss the experience and skills of autonomic nerve preservation in 3D laparoscopic surgery, including pelvic autonomic nerve anatomy, selection of operation methods and key points during operation.