腹腔镜D3淋巴清扫联合保留盆腔自主神经直肠癌根治术对男性性功能的影响

Male sexual function after D3 lymphadenectomy combined with pelvic autonomic nerve preservation by laparoscopic and open surgery for rectal cancer

目的对比分析腹腔镜和开腹联合保留自主神经的D，直肠癌根治术对男性性功能的影响。方法采用前瞻性研究的方法，将我院2006年6月至2007年10月入选的男性直肠癌患者119例随机分别进行开腹（OS组59例）和腹腔镜（Ls组60例）手术，两组病例均采用联合保留自主神经的D，直肠癌根治术。在术前和术后3、6和12个月，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。结果术后3次随访结果显示，Ls组性功能障碍总发生率分别为23.3％、18.3％和11.6％，OS组分别为32.2％、27.1％和16.9％；两组比较，差异无统计学意义（P〉0.05）。结论腹腔镜D，淋巴清扫联合保留自主神经的直肠癌根治术能够达到与开腹手术相同的效果。

Objective To evaluate male sexual function in a series of rectal cancer patients randomized to laparoscopic （LS） or open surgery （OS）. Methods Between June 2006 and October 2007, a total of 119 patients with rectal cancer were randomly assigned to laparoscopic（n=60） or open（n=59） resection group. All the patients were treated by D3 lymphadenectomy combined with pelvic autonomic nerve preservation （PANP） technique. Sexual function was assessed by International Index of Erectile Function（ⅡEF） before surgery and on 3, 6 and 12 months after operation. Results Sexual dysfunction rate of LS and OS at 3rd month after operation were 23.3% and 32.3% respectively, and 18.3% vs 27.1% after 6 months, and 11.6% vs 16.9% after 12 months. There were no significant difference between LS and OS in sexual dysfunction rate after surgery. Conclusions Laparoscopic D3 lymphadenectomy combined with PANP is not associated with higher sexual dysfunction rate, and the sexual function after laparoscopic surgery is satisfactory.