保留盆腔自主神经的全直肠系膜切除术对中、低位直肠癌患者术后排尿和性功能的影响

目的:探讨保留盆腔自主神经的全直肠系膜切除术后患者排尿及性功能的变化。方法:行保留盆腔自主神经(PANP)加全直肠系膜切除术(TME)的中、低位DukesB期的直肠癌患者38例作为研究组,同期行TME的DukesB期患者35例作为对照组。研究组中低位前切除(LAR)21例,经腹会阴联合切除(APR)17例;对照组中LAR20例,APR15例。观察并比较二组患者术前后排尿、性功能之变化。结果:研究组与对照组术后排尿功能障碍发生率分别为15.7%(6/38)与40%(14/35)(P=0.013);研究组LAR与APR组性功能障碍发生率分别为9.5%(2/21)、29.4%(5/17),总的性功能障碍率为18.4%(7/38);对照组中分别为35%(7/20)、73.3%(11/15)和51.4%(18/35),研究组性功能障碍发生率明显低于对照组(P=0.002)。结论:Dukes B期患者行保留盆自主神经的全直肠系膜切除术能明显降低术后排尿、性功能障碍的发生率,提高患者术后生活质量。

The influence of pelvic autonomic nerve preservation with total mesorectal excision on urinary and sexual function in mid and low rectal cancer

Objective:To evaluate the changes of urinary and sexual function after pelvic autonomic nerve preservation with total mesorectal excision operation in patients of rectal cancer . Methods:Fifty-two patients of Dukes B stage received The PANP following TME with follow-up was complete in 38 cases while TME in 35 cases of Dukes B from January 2004 to August 2006. The urinary and sexual dysfunctions of patients in case and control group were analyzed retrospectively by case-control study. Urinary and sexual function were evaluated by means of questionnaires before and after operation.Results:The micturation dysfunction rate was 15.7%(6/38) and 40%(14/35) ,the sexual dysfunction rate was 18.4%(7/38) and 51.4%(18/35)in case and control group respectively,with the difference being significant(P=0.013,P=0.002).Conclusion:The PANP following TME for rectal cancer could reduce sexual and micturition disorder rate and improve the quality of life of the patients after operation.