女性直肠癌直肠系膜全切除术后排尿、性功能的调查

Female urogenital dysfunction after total mesorectal excision for rectal cancer.

目的了解女性盆腔自主神经解剖及女性直肠癌直肠系膜全切除（TME）术后排尿、性功能的情况。方法对36例女性直肠癌行直肠系膜全切除术后患者，通过随访和问卷调查表的方法调查泌尿系症状和性功能状况。结果术前9例（25％）有性生活，术后仍保持性生活，但有不适感，其中5例性欲减退。术前4倒有尿频、夜尿症，术后23例（64％）有夜尿症，5例（14％）有压迫性尿失禁，其中75％患者症状持续2个月以上。所有上述并发症主要发生于低位直肠癌行经腹会阴联合切除及既往有子宫切除手术史者。结论直肠癌手术要涉及盆底，无视神经的保护与术后排尿障碍有关，其与既往有妇科手术史的关系值得进一步评估。

Objective To examine urinary and sexual dysfunction in women after total mesorectal excision （ TEM ）. Methods Urogenital dysfunction was assessed through interview and questionnaire. 36 patients had undergone total mesorectal excision for rectal cancer. Results Preoperatively 9 （25% ） were sexually active,and they remained postoperatively although all described some discomfort. Five of the patients sexually active described reduced libido. Preoperatively 4 patients described urinary frequency and nocturia. Postoperative urinary symptoms developed in23 （ 64% ） reporting the development of nocturia ,5 （ 14% ） developed stress incontinence. Of those with symptoms, 75% persisted longer than two months after surgery. Symptoms were predominant in those patients with low rectal cancers ,particularly those undergoing abdomino-perineal excision and in those who had previously undergone abdominal hysterectomy. Conclusion The operation of rectal cancer involves in to the pelvic floor. Careless of nerve preservation is associated with the development of worsening nooturia and stress incontinence. Further studies are warranted to assess the interaction with previous gynaecological surgery.