腹腔镜D3淋巴结清扫联合保留盆腔自主神经的直肠癌根治术对男性患者排尿功能的影响

目的 探讨腹腔镜D3淋巴结清扫联合保留盆腔自主神经的直肠癌根治术对男性患者排尿功能的影响.方法 将2006年8月至2007年8月西南医院收治的119例男性直肠癌患者,按随机数字表法分为开腹组(59例)和腹腔镜组(60例).术后3个月采用尿流动力学和国际前列腺症状(IPSS)评分的方法,分析两组患者术后排尿功能情况.计量资料采用配对t检验.结果 腹腔镜组与开腹组术后IPSS评分分别为(10.9±2.9)分和(11.5±3.1)分,两组比较差异无统计学意义(t=-1.309,P>0.05).腹腔镜组与开腹组术后最大尿流率分别为15.2 ml/s和15.0 ml/s,排尿量分别为150.1 ml和140.9 ml,残余尿量分别为6.1 ml和6.4 ml,最大逼尿肌收缩压分别为43.3 cm H2O(1 cm H2O=0.098 kPa)和45.6 cm H2O,最大尿道压分别为77.5 cm H2O和72.3 cm H2O,以上指标两组比较差异无统计学意义(t=1.22,-2.12,-1.73,-1.35,-1.64,P>0.05).结论 采用腹腔镜技术进行的D3淋巴结清扫同时保留盆腔自主神经的直肠癌根治术是可行的,该技术没有增加自主神经损伤的几率,疗效与开腹手术相当.

Influence of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation on the urinary function of male patients with rectal cancer

Objective To investigate the influence of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation on the urinary function of male patients with rectal cancer. Methods From August 2006 to August 2007, 119 male patients with rectal cancer who had been admitted to Southwest Hospital were assigned to open surgery group (n=59) and laparoscopic group (n=60) according to the random number table. Three months after the operation, the urinary function of patients was assessed by urodynamics investigation and international prostate symptom score (IPSS). Differences in measurement data were compared with paired t test. Results There was no significant difference in IPSS between laparoscopic group (10.9±2.9) and open surgery group (11.5±3.1) (t=-1. 309, P>0.05). The maximum flow rate, voided volume, residual urine volume, detrusor contraction pressure and maximum urethral pressure were 15.2 ml/s, 150.1 ml, 6.1 ml, 43.3 cm H2O (1 cm H2O=0.098 kPa) and 77.5 cm H2O in laparoscopic group, and 15.0 ml/s, 140.9 ml, 6.4 ml, 45.6 cm H2O and 72.3 cm H2O in open surgery group, with no statistical difference between the 2 groups (t=1.22, -2.12, -1.73, -1.35, -1.64, P>0.05). Conclusions Laparosceopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation is relatively safe in preserving urinary function, and its efficacy is comparable to that of open surgery.