以盆腔自主神经为解剖标识的腹腔镜低位直肠癌根治术对男性患者术后排尿、性功能影响的研究

摘要

目的 探讨以盆腔自主神经为解剖标识行腹腔镜低位直肠癌根治术对男性患者术后排尿、性功能影响.方法 将本科室2015年1月至2016年12月间符合人选标准的54例男性直肠癌患者随机分为L-PANP(Laparoscope-Pelvic autonomic nerve preservation)组和LS (Laparoscope)组,其中L-PANP组的28名患者以盆腔自主神经为解剖标识进行腹腔镜下保留盆腔自主神经的全直肠系膜切除术,LS组的26例患者进行腹腔镜下全直肠系膜切除术.术后3月采用《国际前列腺症状评分表》(IPSS),分析两组病例术后排尿功能情况;术后6月采用《国际勃起功能评分表》(IIEF)、《中国早泄患者性功能评分表》(CIPE),分析两组病例术后性功能情况.结果 术后3月L-PANP组患者排尿功能障碍发生率、IPSS总分均显著低于LS组;术后6月L-PANP组患者性功能障碍发生率均显著低于LS组,IIEF总分、CIPE总分均显著高于LS组,差异均有统计学意义(均P＜0.05).结论 以盆腔自主神经(PAN)为解剖标识进行腹腔镜下低位直肠癌根治术,可在贯彻TME理念的同时,最大程度地降低对男性患者术后排尿功能及性功能的影响.%Objective To investigate the effect of laparoscopic radical resection using pelvic autonomic nerves as anatomical landmarks on urination and sexual function in male patients with low rectal cancer undergoing surgery.Methods 54 male patients with rectal cancer according to the inclusion criteria who were treated in our hospital from January 2015 to December 2015 were randomly assigned into L-PANP (Laparoscope-Pelvic autonomic nerve preservation) group (28 patients) and LS (Laparoscope) group (26 patients).Patients in the L-PANP group received autonomic nerves preservation in laparoscopic total mesorectal excision using pelvic autonomic nerves as anatomical landmark.Patients in the LS group received laparoscopic total mesorectal excision.The urination function was assessed using the International symposium on Prostate Symptom Scale (International Prostate Symptom Score,IPSS) 3 months after surgery.The sexual function was assessed using the International Index of Erectile Function (IIEF) and the Chinese Index of sexual Function for Premature Ejaculation (CIPE) 6 months after surgery.Results The incidence of urinary dysfunction and IPSS scores 3 months after surgery in the L-PANP group were significantly lower than those in LS group.The incidence of sexual dysfunction in L-PANP group was significantly lower than that in LS group,IIEF and CIPE scores 6 months after surgery in L-PANP group were significantly higher than those in LS group.The differences were statistically significant (all P ＜ 0.05).Conclusion Laparoscopic radical resection for low rectal cancer using pelvic autonomic nerves as anatomical landmarks can improve the quality of life of male patients after surgery and at the same time adherence to the TME principle.