直肠系膜全切除术后排尿、性功能障碍的调查

目的 了解直肠系膜全切除术（TEM）后排尿，性功能障碍的情况。方法 分别于手术前及术后3个月进行自主尿流速率，残余尿量和膀胱逼尿压等尿流动力学检查，分别在手术前及术后6个月对泌尿系症状和性功能状况通过问卷调查表的方法进行调查，每个病人都以手术前，后的结果作自身对照。结果 连续68例中53例接受了直肠系膜全切除，15例作部分直肠系膜切除（PEM），术前65例均接受了上述方法的检查，58例接受了上述方法的复查，3例术前被确定有逼尿功能降低，6例术后发展成膀胱麻痹，2例出现尿潴留。32例男病人中有4例发展成某种程度的勃起功能减退，其中1例阳萎，2例不能射精。所有上述并发症均发生于TEM组。结论 直肠癌直肠系膜全切除术后并发排尿，性功能障碍的并不多见。

Bladder and Sexual Dysfunction after Mesorectal Excision for Rectal Cancer

Objective To examine the frequency of urinary and sexual dysfunction after Total Mesorectal Excision(TEM).Methods Spontaneous flowmetry,residual volume of urine measurement and urodynamic examination,including cystomerry and simultaneous detrusor pressure and urinary flow recording,were carride out before and 3 months after curative rectal excision.Urinary symptoms and sexual function were evaluated by means of questionnaires before and after operation.Each patient served as his or her own control.Results Among 68 consecutive patients,53 of whom were performed total mesorectal excision and fifteen a partial mesorectal excision(PEM),were examined before surgery and 58 again after operation.In three patients,a weak detrusor was detected before operation.Six patients developed signs of bladder denervation after operation.Uroschesis appeared in two women.Four of 32 men reported some reduction in erectile function and one became impotent.Two men reported retrograde ejaculaton.All the complications were seen in the TEM group.Conclusions Mesorectal excision for rectal cancer resulted in a low frequency of serious bladder and sexual dysfunction.