直肠癌保肛手术中侧方清扫保留盆腔自主神经124例的疗效评价

目的探讨直肠癌保肛手术中侧方淋巴结清扫和保留盆腔自主神经的临床疗效。方法回顾性分析124例直肠癌保肛手术患者经侧方淋巴结清扫和保留盆腔自主神经后的排便、排尿、性功能及术后生存情况。结果112例患者（90．3％）于术后3d内拔除尿管,平均导尿时间为（58．3±2．1）h。最大尿意尿量为（401．2±23．1）ml,残余尿量为（28．2±2．2）ml。19例术后发生大便失禁,11例经排便训练后基本恢复,2例自行缓解。术后问卷调查98例患者的性功能显示：62．3％的患者可以正常勃起,57．1％的患者有正常的性功能。保留自主神经患者的5年生存率为61．2％。结论直肠癌保肛手术中侧方淋巴结清扫和保留盆腔自主神经能良好保留肛门功能并减少术后排尿及性功能障碍的发生,不影响生存率。

Effect of lateral lymph nodes dissection and autonomic nerve preservation in anterior resection for rectal cancer: 124 cases review

OBJECTIVE: To investigate the clinical effect of lateral lymph nodes dissection and autonomic nerve preservation in anterior resection for rectal cancer. METHODS: One hundred and twenty-four patients with rectal cancer underwent anterior resection with lateral lymph nodes resection and autonomic nerve preservation. The patients were followed-up through post-operational questionnaire about the function of defecation, urination and sex after the operation. And post-operative survival was analyzed retrospectively. RESULTS: Urinary catheters were removed in 112 cases (90.3%) in 3 days post operation, the mean time of indwelling catheter was (58.3 +/- 2.1) h. Nineteen patients experienced fecal incontinence, 12 cases of them recovered through release-training and one recovered spontaneously. Of the 98 questionnaire respondents, 61 cases (62.3%) could erect normally, and 56 cases (57.1%) had normal sexual function. The max-micturition-desire urine volume was (401.2 +/- 23.1) ml and the residual urine volume was (28.2 +/- 2.2) ml. Five year survival rate of all the patients was 61.2%. CONCLUSIONS: Lateral lymph nodes dissection and autonomic nerve preservation in anterior resection for rectal cancer can decrease the post-operative dysfunction of defecation, urination and sex life and does not affect the survival.