男性直肠癌切除术后性功能障碍分析

对25例男性直肠癌切除后性功能进行调查。平均年龄为42．5岁，Miles手术18例，性欲减退8例（44．4％），勃起障碍11例（61.1％），射精障碍13例（72．2％）。Dixon手术7例，性欲减退1例（14.3％），勃起障碍1例（14.3％），射精障碍2例（28．6％）。认为手术损伤盆腔神经是造成术后病人性功能障碍的直接和主要因素。防治关键在于术中完整地保护植物神经，注意剥离层次和切除范围。     

Urogenital dysfunction after laparoscopic surgery for rectal or sigmoid colon cancer

Background/objectiveUrogenital dysfunction is a common complication after surgery for sigmoid colon or rectal cancers and may result from various causes. Herein, we evaluated urogenital dysfunction and the associated factors after laparoscopic surgery at different follow-up times.MethodsWe conducted a prospective study on 91 patients who were diagnosed with sigmoid colon and rectal cancers and underwent laparoscopic surgery during 2014–2016.Voiding and male and female sexual dysfunctions following surgery were evaluated by the International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and Female Sexual Function Index-6 (FSFI-6), respectively. Urogenital function was compared at pre-surgery and 3 and 12 months postoperatively, and factors associated with urogenital dysfunction were identified.ResultsThe overall urinary function after surgery was better when compared to that at pre-surgery; however, there was deterioration in both male and female sexual functions. The mean preoperative IPSS, IIEF-5, and FSFI-6 scores were 9.35, 12.18, and 6.09, respectively. The mean differences among IPSS, IIEF-5, and FSFI-6 at 12 months postoperatively and pre-surgery were ?3.08 (95% confidence interval [CI] ?4.77 to ?1.40), ?2.57 (95% CI -4.33 to ?0.80), and ?2.58 (95% CI -4.73 to 0.42), respectively. Multivariate analysis demonstrated that age ≤60 years (odds ratio 4.22) and postoperative complications (odds ratio 2.77) were correlated with erectile dysfunction.ConclusionVoiding function improved after laparoscopic surgery in both sigmoid colon and rectal cancer patients. However, sexual function in both male and female patients was worse. Age ≤60 years and postoperative complications were strongly associated with male sexual dysfunction.     

直肠拖出吻合式腹腔镜直肠癌手术

目的探讨经直肠拖出吻合式腹腔镜直肠癌手术的临床价值。方法术前结肠镜确诊为直肠癌60例,肿瘤距肛门3~12cm。腹腔镜下直肠癌根治切除,游离直肠至齿状线上约2cm处,将直肠拖出吻合器吻合肠段。结果60例顺利完成腹腔镜直肠癌根治切除,无中转开腹及严重并发症。手术时间89~179min,(120±25)min;术中出血量48~147ml,(75±26)ml;住院时间5~12d,(8.3±1.5)d;住院费8680~15800元,(9900±750)元。60例随访12~25个月,平均22.3月,无腹腔大出血、肛门狭窄、肠漏等严重并发症,术后2个月后无大便失禁。1例术后12个月局部复发,腹腔镜下二次手术。结论直肠拖出吻合式腹腔镜直肠癌手术安全、疗效确切,术后恢复快。     

腹腔镜中低位直肠癌根治术对男性患者性功能及排尿功能的影响

目的 探讨腹腔镜中低位直肠癌根治术对男性患者性功能及排尿功能的影响.方法 回顾性分析2006年5月至2009年3月解放军总医院收治的150例男性中低位直肠癌患者的临床资料,其中腹腔镜组68例,开腹组82例.比较两组患者术后6、12个月勃起功能障碍和射精功能障碍发生率及近、远期排尿功能障碍发生率,计数资料采用x2检验.结果 腹腔镜组与开腹组患者术后6个月勃起功能障碍、术后6个月射精功能障碍、术后12个月射精功能障碍、远期排尿功能障碍发生率分别为15%(10/68)、16%(11/68)、10%(7/68)、0和22%(18/82)、23%(19/82)、21%(17/82)、2%(2/82),两组比较,差异无统计学意义(x2=1.285,1.137,3.013,1.681,P>0.05).腹腔镜组与开腹组患者术后12个月勃起功能障碍、近期排尿功能障碍发生率分别为7%(5/68)、4%(3/68)和17%(14/82)、20%(16/82),两组比较,差异有统计学意义(x=4.565,5.930,P<0.05).结论 腹腔镜中低位直肠癌根治术能减少男性患者盆自主神经损伤,提高患者术后生命质量.

Abstract：

Objective To evaluate the effects of laparoscopic radical resection of mid-low rectal cancer on sexual and urinary functions of male patients. Methods The clinical data of 150 patients with mid-low rectal cancer who were admitted to the PLA General Hospital from May 2006 to March 2009 were retrospectively analyzed. Sixty-eight patients were allocated to laparoscopic group and 82 to open group. The incidences of erectile and ejaculatory dysfunction and the short- and long-term urinary dysfunction of patients in the 2 groups were compared seperately at 6 and 12 months after the operation. All data were analyzed using the chi-square test. Results The incidences of erectile and ejaculation dysfunction at 6 months after operation, incidence of ejaculation dysfunction at 12 months after operation, and long-term urinary dysfunction were 15% (10/68), 16% (11/68), 10% (7/68) and 0 in the laparoscopic group, and 22% (18/82), 23% (19/82), 21% (17/82) and 2% (2/82) in the open group, respectively, no significant difference between the two groups was found (x2 = 1. 285, 1. 137, 3. 013, 1.681, P>0. 05). The incidences of erectile dysfunction at 12 months after operation and short-term urinary dysfunction were 7% (5/68) and 4% (3/68) in the laparoscopic group, and 17% (14/82) and 20% (16/82) in the open group, respectively, a significant difference between the two groups was observed (x = 4. 565, 5.930, P <0.05). Conclusion Laparoscopic radical resection of mid-low rectal cancer can reduce the injury of pelvic autonomic nerve and improve the life quality of patients.     

Urogenital function 3 years after abdominoperineal excision for rectal cancer

Aim

The aim of this study was to explore urogenital dysfunction and associated risk factors after treatment of rectal cancer, in a large national cohort of patients 3 years after abdominoperineal excision, and to compare outcomes with a reference population and a cohort of patients operated for prostate cancer.

Method

Patients treated with abdominoperineal excision in 2007–2009 were identified using the Swedish Colorectal Cancer Registry. All consenting patients received a questionnaire. A sample of the Swedish population was contacted and completed a questionnaire. Patients undergoing radical prostatectomy in a prospective multicentre trial received questionnaires 24 months after surgery.

Results

In the abdominoperineal excision, reference and radical prostatectomy populations 72%, 51% and 91% of the questionnaires were returned. Within the abdominoperineal excision group 36% of the men and 57% of the women were incontinent postoperatively. Fifteen per cent and 37% of men and women in the reference group were incontinent. Two years after radical prostatectomy 49% were incontinent. Seventy‐four per cent of the men had erectile dysfunction after abdominoperineal excision. Nineteen per cent of the women experienced reduced ability to reach orgasm. Fewer men and women experienced their present sex life as satisfying after abdominoperineal excision for rectal cancer compared with the reference population.

Conclusion

A large proportion of patients endure persistent urogenital dysfunction after abdominoperineal excision for rectal cancer as do men after radical prostatectomy. Effects on sexual and urinary function should be part of preoperative information and after surgery patients should be asked about function in order to identify those in need of further assistance.     

直肠癌治疗术后勃起功能障碍的发病机制

直肠癌是常见的消化道恶性肿瘤之一,近年来发病率逐年上升。目前治疗方法包括手术治疗、放化疗以及多种方式联合的综合治疗。性功能障碍尤其是勃起功能障碍(ED)是男性直肠癌治疗术后最常见的并发症之一,严重降低了患者术后的生活质量,既往公认其主要原因是损伤了盆腔自主神经。近年的研究发现其发病机制不仅如此,而是一个复杂的病理生理过程,包括神经、血管、心理因素等。现就直肠癌治疗术后ED的发病机制作一综述,为临床上预防和治疗术后ED提供理论依据,从而降低其发生率,提高患者的生活质量。     

低位直肠癌前切除术后早期腹泻与吻合口瘘的关系

目的探讨低位直肠癌前切除术后早期腹泻（术后1～7d）与吻合口瘘的关系。方法回顾性分析河南省肿瘤医院2004年5月至2007年5月间行低位直肠癌（肿瘤距肛缘4～7cm）前切除术的192例（A组）和2007年7月至2010年1月间行低位直肠癌前切除术的236例（B组）患者的临床资料。结果A组患者术后早期腹泻发生率为19．3％（37／192）．其中9例予止泻药物治疗;早期腹泻和无早期腹泻患者吻合口瘘发生率分别为16．2％（6／37）和5．2％（8／155）,差异有统计学意义（P〈0．05）。B组患者术后早期腹泻发生率为16．5％（39／236）,均予以止泻药物治疗,其中3例患者接受肛门蕈状双套管冲洗引流：早期腹泻和无早期腹泻患者吻合口瘘发生率分别为5．1％（2／39）和4．1％（8／197）,差异无统计学意义（Х^2=0．02,P〉O．05）。A组与B组早期腹泻发生率的比较差异无统计学意义（P〉0．05）,但早期腹泻患者中吻合口瘘发生率B组明显低于A组（P〈0．05）。结论低位直肠癌前切除术后早期腹泻提示可能存在吻合口瘘．积极治疗术后早期腹泻可一定程度预防吻合口瘘的发生。     

功能性直肠癌扩大根治术对男性性功能的影响

目的 观察盆腔自主神经的解剖,减少直肠癌扩大根治术中对自主神经的损伤。分析在全直肠系膜切除基础上行保留神经的功能性直肠癌扩大根治性术对男性直肠癌患者性功能的应用价值,并与传统扩大根治术比较。方法 采用对6例盆腔器官作解剖学研究,观察盆腔自主神经的走行及分布结果,并通过调查表的方式调查306例男性中下段直肠癌扩大根治术病例保留神经组和传统扩大根治术组性功能障碍的发生率。结果 分析两组患者术后勃起功能障碍、性兴趣减退、射精功能障碍的发生率分别35.2％ (44/125)、62.2％ (46/74),76.8％( 19/125)、52.7％( 30/74),15.2％(29/125)、40.5％(35/74),差异有统计学意义(P＜0.05)。结论 保留盆腔自主神经的直肠癌扩大根治术可以改善患者的性功能障碍率。     

Female sexual dysfunction

Female sexual dysfunction is a common problem with detrimental effects on woman’s quality of life. It also has an economical and societal impact. It is defined as disorders of sexual desire, arousal, orgasm, and sexual pain, which lead to personal distress. The etiology of sexual dysfunction is frequently multifactorial as it relates to general physical and mental well-being, quality of relationship, past sexual functioning, social class, education, employment, life stressors, personality factors, the presence of a sexual partner, and partner’s age and health. It is very important to adopt the most efficient approach to gather information, and this may be achieved via standardized questionnaires or open-ended questions. Therapy should be tailored according to the patient’s needs and may involve a multidisciplinary team approach including psychosexual counselor/sexologist/therapist and the physician. There is still more work needed to optimize the care of women with this problem. Priority should be given to international standardization and training of health care professionals.     

腹腔镜下直肠癌根治术保留前列腺支神经的手术体会

【摘要】〓目的〓探讨腹腔镜下直肠癌根治术保留前列腺支对男性性唤起及射精功能的影响。方法〓收集我院2012年1月~2015年10月直肠癌患者80例,所有患者均接受腹腔镜下直肠癌根治术,根据有无保留前列腺支神经进行分组,保留者为观察组,未能保留者为对照组;回顾性分析两组患者临床资料,比较术后性唤起及射精功能恢复情况。结果〓观察组术后性唤起及射精功能障碍与对照组比较差异均有统计学意义(P < 0.05)。结论〓腹腔镜下直肠癌根治术保留前列腺支有利于患者术后及时恢复性唤起及射精功能,提高患者的生存质量,应该在基层医院推广应用。     

Male sexual and urinary function after laparoscopic total mesorectal excision

Background  Urinary and sexual dysfunction are potential complications of rectal surgery for cancer. This study retrospectively evaluated the frequency of such complications after laparoscopic total mesorectal excision (LTME) with autonomic nerve preservation. Methods  For this study, 50 men younger than 75 years who underwent radical LTME for mid and low rectal cancer were followed up for at least 12 months, interviewed, and administered a standardized questionnaire about postoperative functional outcomes and quality of life. Results  Sexual desire was maintained by 55.6%, ability to engage in intercourse by 57.8%, and ability to achieve orgasm and ejaculation by 37.8% of the patients. Distance of the tumor from the anal verge and adjuvant or neoadjuvant treatments were the significant predictors of poor postoperative sexual function. Seven patients (14%) presented transitory postoperative urinary dysfunction, all of whom were medically treated. Tumor stage and distance from the anal verge were independently associated with the postoperative global International Prostatic Symptom Score (IPSS). No differences were observed in urinary quality of life. Conclusions  In this series, LTME did not reproduce or improve on sexual and urinary dysfunction outcomes obtained in the best open TME series. Further trials are needed to evaluate functional outcome in rectal cancer patients.     

The long-term voiding function and sexual function after pelvic nerve-sparing radical surgery for rectal cancer

BACKGROUND: The aim of the present study is to symptomatically analyze the extent to which pelvic nerve-sparing radical surgery for rectal cancer impacts on long-term voiding and male sexual function. METHODS: A self-administered questionnaire was mailed to 68 patients who underwent pelvic nerve-sparing radical surgery for invasive rectal cancer with 52 responses (28 men and 24 women; 27 complete and 25 incomplete preservation; response rate 76.5%). Each patient was asked to record if there had been any changes in lower urinary tract symptoms after surgery. Sexual function was also investigated in men. RESULTS: Of the 52 patients, 48 (92%) maintained voluntary voiding without catheterization in the long term. Clean intermittent self-catheterization was performed in only four patients with incomplete preservation because of persistent voiding dysfunction. Subjectively, approximately 60% of the patients remained unchanged in lower urinary tract symptoms after surgery. The satisfaction rate regarding the current voiding status was significantly higher in women than in men (83% versus 61%, P = 0.0294), but was not significantly different between those with complete (76%) and incomplete preservation (64%). Despite the acceptable urinary status, 88% of men had some deterioration in the erectile function, regardless of the types of surgical procedures. Overall, 64% of men were unsatisfied with the current sexual function. CONCLUSIONS: Pelvic nerve-sparing radical surgery for rectal cancer preserved the long-term voiding function in the majority of patients. In completely preserved patients and in women, symptomatic outcomes were more satisfactory. Postoperative erectile dysfunction was found to be a serious problem, even in complete nerve-sparing procedure.     

Quality of life after surgery for rectal cancer with special reference to pelvic floor dysfunction

Aim Conventional outcomes such as survival, tumour recurrence and complication rates after surgery for rectal cancer have been rigorously assessed, but the importance of maintaining quality of life (QOL) after surgery for rectal cancer has received less attention. The aim of the current study was to analyse QOL and the occurrence of pelvic dysfunction after the surgical treatment of rectal cancer. Method Between May 2005 and May 2008, 150 patients with rectal cancer underwent abdominoperineal resection (APR) or anterior resection (AR). Seventy‐four answered two preoperative questionnaires. At a follow up of 1 year, 65 were alive without sign of recurrence and answered the same questionnaires: (a) validated RAND 36‐item health survey QOL questionnaire; and (b) self‐administered disease‐related questionnaire with special reference to anorectal and urogenital function. Results The postoperative general QOL was similar after surgery, and mental functioning was better (P < 0.001). Problems with physical functions were associated with anal dysfunction after AR (P < 0.001) and problems with social functioning were associated with urinary dysfunction (P = 0.038). At 1 year after surgery, urinary incontinence was worse (P = 0.026) after all operations, and the incidence of dysuria was higher after APR than AR (P = 0.001). Male sexual function also worsened (P = 0.060). Anorectal dysfunction caused more inconvenience among patients who underwent AR (P = 0.028). Preoperative radiation was associated with postoperative ejaculation problems (P = 0.028) and anal incontinence (P = 0.012). Conclusion Factors affecting QOL and pelvic floor function should be taken into account when making treatment decisions in rectal cancer.     

Women's sexual dysfunction: a review of the "surgical landscape"

OBJECTIVES: To assess the impact of urogynaecologic surgery for stress urinary incontinence, oncologic pelvic surgery, and hysterectomy on women's overall sexual health. METHODS: We used Ovid and PubMed (updated January 2006) to conduct a literature electronic search on MEDLINE that included peer-reviewed English-language articles. We analysed all studies identified that provided any functional outcome data about urogynaecologic surgery for the treatment of stress urinary incontinence, radical cystectomy for bladder cancer, surgery for rectal cancer, and hysterectomy. Because of the substantial heterogeneity of outcome measures and follow-up intervals in case studies, we did not apply meta-analytic techniques to the data. RESULTS: Most studies showed that either urogynaecologic or oncologic pelvic surgery may have a significant impact on women's sexual health. Epidemiology varied widely among the studies and reported either improvement or impairment of postoperative sexual functioning, due to different definitions, study designs, and small cohorts of patients. An increasing number of studies have prospectively examined this issue and have found often controversial findings about the role of pelvic and perineal surgery in women's sexual health. CONCLUSIONS: Although numerous controversies exist, data demonstrate an overall positive impact of the surgical repair for stress urinary incontinence on resolution of coital incontinence, coupled with an improvement of overall sexual life. In contrast, genitourinary and rectal cancers are commonly associated with treatment-related sexual dysfunction, but few studies rigorously assessed women's postoperative sexual function after major oncologic pelvic surgery. Data about the functional outcome after hysterectomy are often contradictory. Adequately powered prospective clinical trials are needed.