功能性直肠癌扩大根治术对男性性功能的影响

Anatomic study of extended radical resection of rectal carcinoma and evaluation of sexual dysfunction of man after the surgery

目的观察盆腔自主神经的解剖，减少直肠癌扩大根治术中对自主神经的损伤。分析在全直肠系膜切除基础上行保留神经的功能性直肠癌扩大根治性术对男性直肠癌患者性功能的应用价值，并与传统扩大根治术比较。方法采用对6例盆腔器官作解剖学研究，观察盆腔自主神经的走行及分布结果，并通过调查表的方式调查306例男性中下段直肠癌扩大根治术病例保留神经组和传统扩大根治术组性功能障碍的发生率。结果分析两组患者术后勃起功能障碍、性兴趣减退、射精功能障碍的发生率分别35．2％（44／125）、62．2％（46／74），76．8％（19／125）、52．7％（30／74），15．2％（29／125）、40．5％（35／74），差异有统计学意义（P〈0．05）。结论保留盆腔自主神经的直肠癌扩大根治术可以改善患者的性功能障碍率。

Objective The anatomy of pelvic autonomic nerves was studied in order to alleviate autonomic netwes damage durinsrectal cancer sursery. To investisate the clinical outcome on dccreasing the incidence of post-operative sexual dysfunction during extended radical resection with never-preservation for rectal cancer. Methods Anatomical dissection was performed on the pelvic organs of 6 male human cadavers to observe the disposition of pelvic autonomic nerves. Questionnaires were obtained from 306 randomly selected patients who were previously treated with surgery （group 1 ： nerve-kept; group 2： control）. Retrospective analysis was used to show the significance of nerve-preservation procedure. Results Erectile dysfunction, decreased sexual desire and ejaculation dysfunction were observed： 35. 2% （44/125） and 62. 2% （46/74）, 76. 8% （19/125） and 52. 7% （30/74）, 15.2% （29/125） and 40. 5% （35/74） re- spectively （P 〈 0. 05 ）. Conclusion Extended radical resection with never-preservation could decrease the incidence of post-operative sexual dysfunction and improve life quality.