保留盆腔自主神经对男性直肠癌患者术后性功能的作用

Study on the Effect of Postoperative Sexual Function after Pelvic Autonomatic Nerve Preservation on Rectal Cancer Patients

目的:观察保留盆腔自主神经的根治性切除术对男性直肠癌手术患者性功能的作用,并与非保留盆腔自主神经的直肠癌手术患者相比较,了解保留盆腔自主神经对保留男性直肠癌患者性功能的应用价值。方法:选择2004年6月至2007年5月我院63例直肠癌患者,随机分为两组,即保留盆腔自主神经组(行保留盆腔自主神经的根治术,PANP)31例和对照组(行根治术,但不解剖暴露盆腔自主神经)32例。观察:①性功能指标:采用问卷调查的方法,了解男性患者术后能否维持阴茎勃起并坚挺地进入阴道,性交后有无射精;勃起功能分为3级:Ⅰ级是能够完全勃起,与术前无差别,为勃起功能正常;Ⅱ级是不同程度的勃起功能下降,仅能够部分勃起,与术前比较勃起硬度下降;Ⅲ级是完全无勃起,勃起功能完全丧失。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。②局部复发率。结果:PANP组勃起功能障碍10例,发生率为32.25%,对照组勃起功能障碍25例,发生率为78.13%;PANP组射精功能障碍8例,发生率为25.81%,对照组射精功能障碍24例,发生率为75%。经X2检验P均<0.05,差别有显著意义。PANP局部复发2例,复发率为6.45%,对照组局部复发3例,复发率为9.38%,经X2检验P>0.05,差别不显著。结论:男性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根治术相比较,可以显著地保留性功能,并且没有增加局部复发率。

Objective： To observe the effect of curative excision in pelvic autonomic nerve preservation （ PANP ） on the male rectal cancer patients＇ sexual functions, and compare with non - PANP, and observe the application value of curative excision in pelvic autonomic nerve preservation （ PANP）. Methods： Sixty three male rectal cancer patients treated at the Second Affiliated Hospital of Medical College of Shantou University between June 2004 and May 2007 were divided randomly into 2 groups with 31 in one group： PANP group （ curative excision of PANP was performed） and 32 in control group （ curative excision of PANP was performed without dissecting to exoose oelvic autonomic nerve ）.The following markers were observed： 1 markers of sexual function ： To investigate the rectal cancer curative excision with questionnaire after operation whether they can maintain the hard of erectile penis to insert vagina, whether they have ejaculation after coitus; Erectile function was divided into 3 grades： I as normal erection, which has no difference with preoperative; Ⅱ as incomplete or partly erection, which has breakdown with the hard of erectile penis compared with preoperative; Ⅲ as completely none of erection, loss of erection 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. 2 Local recurrence rate. Results： 10 cases of PANP group have difficult with erectile function covered 32.25%, compared with 25 cases of control group accounted 78.13% ; 8 cases of PANP group have ejaculation function disturbance covered 25.81% , compared with 24 cases of control group covered 75%. Both of P value are less than 0.05 counted with chisquare test. The differerfce of two groups has significant meaning. 2 cases of PANP group have local recurrence covered 6.45% , compared with 3 cases of control group covered 9.38% , P value was more than 0.05, and no significant differences were found with chisquare test. Conclusion： Compared with non- PANP, curative excision in pelvic autonomic nerve preservation （PANP） on the male rectal cancer patients may markedly remain their sexual function, and the local recurrence rate has not increased.