保留盆腔自主神经对男性局部进展期直肠癌患者术后排尿功能及性功能的影响

Effects of pelvic autonomic nerve preservation on postoperative urinary and sexual functions of male patients with locally advanced rectal cancer

目的:观察保留盆腔自主神经的根治性切除术对男性局部进展期直肠癌患者排尿功能及性功能的应用价值,并与非保留盆腔自主神经术相比较。方法:选择2001-01/2005-01广西医科大学第一附属医院收治的106例男性局部进展期直肠癌患者,随机分为保留盆腔自主神经组(行保留盆腔自主神经的根治性切除术)53例和对照组(行根治术,但不解剖暴露盆腔自主神经)53例。观察以下几项:①术后排尿功能:I级为正常,Ⅱ级残余尿<50mL,Ⅲ级残余尿>50mL;IV级熏重度排尿障碍,需导尿。②性功能指标:勃起功能采用勃起功能障碍国际指数问卷调查表中的问题1,2,每个问题满分为5分,评分越高功能越好;射精功能分为3级:I级是有射精,射精量正常或减少;Ⅱ级是出现逆行射精,有射精功能障碍:Ⅲ级是完全无射精。③局部复发率。④5年生存率。结果:106例进入结果分析。①术后排尿功能分级保留盆腔自主神经组优于对照组(P=0.0377)。②术后保留盆腔自主神经组勃起功能障碍国际指数问卷调查表得分高于对照组(P=0.0024),射精功能也优于对照组穴P=0.0211雪。③局部复发率保留盆腔自主神经组与对照组比较差异不显著(5.7%,7.6%,P=0.500)。④5年生存率保盆腔自主神经组与对照组比较差异不显著(60.0%,55.6%,P=0.8443)。结论:男性局部进展期直肠癌患者实施保留盆腔自主神经的根治术,与非保留盆腔自主神经术相比较,可以较好地保留排尿功能和性功能,且没有增加局部复发率和降低5年生存率。

AIM： To observe the application value of curative excision in pelvic autonomic nerve preservation （PANP） on the urinary and sexual functions of male patients with locally advanced rectal cancer （LARC）, and compare with non-PANP. METHODS： One hundred and six male LARC patients treated at the First Affiliated Hospital of Guangxi Medical University between January 2001 and January 2005 were divided randomly into 2 groups with 53 in each group： PANP group （curative excision of PANP was performed） and control group （curative excision of PANP was performed without dissecting to expose pelvic autonomic nerve）. The following markers were observed： ①Postoperative urinary function： Ⅰ as normal, Ⅱ as residual urine was less than 50 mL, Ⅲ as residual urine was more than 50 mL Ⅳ as severe urinary dysfunction and in need of urethral catheterization. ②Markers of sexual function： According to question 1 and 2 of International Index for Erectile Function （IIEF） Questionnaire, the erection function was scored by 5 grades, and the higher score meant the better function; Ejaculation function was assigned to 3 grades： Ⅰ as ejaculation existed with normal or decreased amount of ejaculation; Ⅱ as retrograde ejaculation existed accompanying ejaculation dysfunction; Ⅲ as complete absence of ejaculation. ③Local relapse rate. ④Survival rate in 5 years. RESULTS： All the 106 patients were involved in the result analysis. ① The grades of postoperative urinary function were better in PANP group than in the control group （P=0.037 7）. ②Ejaculation function and the scores of IIEF questionnaire in postoperative erectile function were higher in PANP group than in the control group （P=0.021 1,P=0.002 4）. ③There was no significant difference of local relapse rate between beth groups （5.7%, 7.6%, P=0.500 ）.④And difference was insignificant of survival rats in 5 years between beth groups （60.0%, 55.6%, P=0.844 3）. CONCLUSION： Compared with non-PANP, the curative excision of PANP can reserve sexual and urinary functions of male LARC patients, and do not increase the local relapse rate and decrease the survival rate in 5 years.