直肠癌TME术中保留盆腔自主神经对男性性功能及排尿功能的影响

Effect of Pelvic Autonomic Nerve Preservation with Total Mesorectal Excision on Sexual and Urinary Function in Male Rectal Cancer Patients

目的探讨直肠全系膜切除术(TME)中保留盆腔自主神经(PANP)对术后男性患者性功能及排尿功能的影响。方法回顾性分析我院2008年1月至2010年10月期间行直肠癌根治术的84例患者临床资料,根据不同的手术方式分为PANP+TME组(n=41)和TME组(n=43),对2组患者术后排尿及性功能障碍发生率和局部复发率情况进行比较。结果 PANP+TME组与TME组患者术后勃起功能障碍发生率分别为29.3%(12/41)和76.7%(33/43),射精功能障碍发生率为26.8%(11/41)和79.1%(34/43),排尿障碍发生率分别为24.4%(10/41)和79.1%(34/43),2组间差异均有统计学意义(P<0.05)。PANP+TME组和TME组术后局部复发率分别为9.8%(4/41)和11.6%(5/43),2组比较差异无统计学意义(P>0.05)。结论直肠癌在TME基础上行PANP可以降低男性患者术后排尿和性功能障碍的发生率,且并不增加术后肿瘤局部复发率。

Objective To investigate the effect of pelvic autonomic nerve preservation（PANP） with total mesorectal excision（TME） on sexual and urinary function in male rectal cancer patients.Methods Clinical data of eighty-four patients with rectal cancer from January 2008 to October 2010 in our hospital were analyzed.According to different operative techniques,all the patients were divided into two groups： PANP＋TME group（n=41） and TME group（n=43）.The sexual dysfunction,urination disorder rate,and local recurrence rate after operation of patients between two groups were compared.Results Erectile dysfunction rate of patients in TME＋PANP group and TME group was 29.3%（12/41） and 76.7%（33/43）,ejaculation disorder rate was 26.8%（11/41） and 79.1%（34/43）,and urination dysfunction rate was 24.4%（10/41） and 79.1%（34/43）,respectively.The rate of sexual and urinary dysfunction of patients in TME＋PANP group was significantly lower than that in TME group（P0.05）.Local recurrence rate of patients in TME＋PANP group（9.8%,4/41） was similar to that in TME group（11.6%,5/43）,P0.05.Conclusion PANP based on TME can reduce effectively the rate of sexual and urinary dysfunction in male rectal cancer patients,which does not increase the local recurrence rate after operation.