直肠癌手术保留自主神经对男性性功能的影响

Effects of Pelvic Autonomic Nerve Preservation in Excision of Rectal Cancer on Sexual Functions in Male

目的探讨直肠癌根治手术保留盆腔自主神经(PANP)对术后男性性功能的影响。方法以问卷形式调查45例直肠癌 PANP 手术和48例传统根治术手术前后性功能情况,比较分析行直肠癌根治术的PANP 组和传统手术组术后性功能指标及局部复发率。结果 PANP 组45例中完全保护盆底自主神经的21例性功能均达到Ⅰ级,未受损害,占46.7%;受到损害的24例,占53.3%。在48例传统术式的患者中12例达Ⅰ级(25.0%),而36例性功能都受到影响,占75.0%,有显著性意义(P<0.05)。术后局部癌肿复发率PANP 组为8.9%(4/45),未明显高于传统组6.3%(3/48)(P>0.05),复发者均为 DukesC 期患者。结论PANP 组患者术后性功能指标明显优于对照组,说明 PANP 手术与传统根治术相比,前者对直肠癌患者性功能状况有明显改善。但同时需说明:未发生转移的 Dukes A 期和 Dukes B 期可以进行 PANP,不增加局部癌肿复发率,但是对于 DukesC 期患者可能增加局部复发率。所以对于 DkesC 期患者重点应该放在彻底切除肿瘤和淋巴结,而不是保留盆腔自主神经。

Objective To evaluate the effects of pelvic autonomic nerve preservation （PANP） on the sexual functions of male patients during the excision of rectal cancer. Methods The questionnaire survey was made on the sexual functions of 45 male patients undergoing PANP and 48 male patients without PANP. Results After the operation, analyzed the sexual function index and local recurrence rate of the two groups In the 45 cases undergoing PANP, the sexual functions of 21 cases reached the level Ⅰ without impairments {46.7 % ）. And 24 cases with impairments （53.3 % ）. In 48 cases without PANP, the sexual functions of 12 cases reached the level Ⅰ （25.0 % ）. But 36 cases with impairments reached 75.0 %, there existed significant differences（ P 〈 0.05）. The local recurrence rate in those perforated PANP was 8.9 %, while the local recurrence rate in group without PANP was 6.3 %. There were no obvious differences （ P 〉 0.05 ）. The patients with recurrence were in the period of Dukes C. Conclusion The sexual function indexes of those performed PANP were better than those without PANP, which suggested the PANP can improve the sexual functions of rectal cancer patients. But as the same time, The patients during the Duckes A and Duckes B can perform PANP, which will not increase the local recurrence rate. But for the patients in Duckes C it will not. So for the patients in Duckes C, the first target is not the pelvic autonomic nerve preservation but the absolute excision of the tumor and conglobate glands.