腹腔镜D3淋巴结清扫联合保留盆腔自主神经直肠癌根治术对男性生活质量影响的研究

The impact of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation on the quality of life of male patients with rectal cancer

目的探讨腹腔镜D3淋巴结清扫联合保留盆腔自主神经直肠癌根治术对男性患者生活质量的影响。方法将2007年4月至2010年4月我院收治的129例男性直肠癌患者,按随机数字表法分为腹腔镜组(60例)和开腹组(69例),术后第6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。两组患者术后第3、6、12个月,分别采用IIEF问卷对男性性功能进行评价,对比两组病例术后性功能情况。结果腹腔镜组与开腹组术后IPSS评分分别为(11.8±2.81)分和(11.2±3.13)分,两组比较差异无统计学意义(t=-1.307,P>0.05);腹腔镜组与开腹组术后最大尿流率分别为(20.01±3.43)ml/s和(18.12±4.23)ml/s,排尿量分别为(213.81±32.11)ml和(223.72±28.33)ml,残余尿量分别为(2.35±0.33)ml和(2.40±0.35)ml,最大逼尿肌收缩压分别为(49.32±5.83)cmH2O和(48.41±6.27)cmH2O,最大尿道压分别为(80.12±8.32)cmH2O和(80.27±9.25)cmH2O,以上指标两组比较差异无统计学意义(P>0.05);两组患者术后性功能差异无统计学意义(P>0.05)。结论采用腹腔镜技术进行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,疗效与开腹组相当。

Objective To investigate the influence of laparoscopic D3 lymphadenectomy combined with pelvic autonomic nerve preservation on the quality of life of male patients with rectal cancer.Methods From April 2007 to April 2010,129 male patients with rectal cancer who had been admitted to shaoxing people's hospital were assigned to laparoscopic group(n=60) and open surgery group(n=69) according to the random number table.Six months after operation,the urinary function of patients was assessed by urodynamics investigation and international prostate symptom score (IPSS).Sexual function was assessed by International Index of Erectile Function (IIEF) before surgery and on 3,6 and 12 months after operation.Results There was no significant difference in IPSS between laparoscopic group(11.8±2.81)and open surgery group(11.2±3.13)(t=-1.307,P>0.05).The maximum flow rate,voided volume,residual urine volume,detrusor contraction pressure and maximum urethral pressure were (20.01±3.43)ml/s,(213.81±32.11)ml,(2.35±0.33)ml,(49.32±5.83)cm H2O,(80.12±8.32)cm H2O in laparoscopic group and (18.12±4.23)ml/s,(223.72±28.33)ml,(2.40±0.35)ml,(48.41±6.27)cm H2O,(80.27±9.25)cm H2O in open surgery group with no statistical difference between the two groups(P>0.05).The sexual function also was no statistical difference between two groups.Conclusions Laparoscopic D3 lymphadenctomy combined with pelvic autonomic nerve preservation is relatively safe in preserving urinary function and sexual function and its efficacy is comparable to that of open surgery.