直肠癌Miles术保留盆腔自主神经的评价

目的评价直肠癌Miles术保留盆腔自主神经的临床效果. 方法 159例男性直肠癌患者行Miles术结合盆腔自主神经全保留、单侧保留、部分保留,评价术后的肿瘤结果、性功能及排尿功能.结果总的局部复发率为18.2%,5年生存率为63.5%.术后性功能保持勃起、性交者79.2%;能射精者30.8%,其中全保留组为65.1%,单侧保留组为13.8%;阳萎患者为20.8%.术后排尿功能拔除导尿管时能自行排尿且残余尿＜50ml者105例,占66.0%,平均拔管时间为3.2d;残余尿量在50 ～100ml者41例,占25.8%,平均拔管时间为6.8d;残余尿量＞100ml者13例,占8.2%,其中5 例出院时仍需留置导尿管.结论保留盆腔自主神经的Miles术不增加局部复发率,不减低5年生存率,却能改善患者的性功能及排尿功能.

The Assessment of Pelvic Autonomic Nerve Preservation in Miles Operation for Rectal Cancer

Objective To evaluate the clinical effect of pelvic autonomic nerve preservation in Miles operation for rectal cancer.Methods The oncologic and functional outcomes were analyzed in 159 male patients undergoing Miles operation for rectal cancer plus the complete, unilateral, partial pelvic autonomic never preservation.Results The total local recurrence rate was 18.2%. The 5-year survival rate was 63.5%. Of these patients, 79.2% was maintained the ability to engage in se xual intercourse. And 30.8% was capable of achieving ejaculation,among which 65.1% and 13.8% were in complete and unilateral preservation.Impotence was developed in 20.8% of the patients. Spontaneous voiding when the urethral catheter was removed 3.2 days after operation took account for 66.0%,6.8 days for 25.8% patients suffering from temporary urinary dysfunction and 8.2% of those patients led to the long-term urinary dysfunction.Conclusion These data show that the outcome of urinary and sexual function is better after pelvic autonomic nerve preservation in Miles operation for rectal cancer. It is a worthy procedure for the balance between achieving a cure and preserving autonomic function.