保留盆腔自主神经的腹腔镜直肠癌根治术对男性性功能的影响

Sexual Function after Laparoscopic Radical Resection for Rectal Carcinoma with Pelvic Autonomic Nerve Preservation in Male Patients

目的比较腹腔镜与开腹保留盆腔自主神经(pelvic automatic nerve preservation,PANP)的直肠癌根治术对男性患者术后性功能的保护效果。方法 2008年9月～2010年8月对120例男性中低位直肠癌分别行腹腔镜PANP手术(L-PANP组,n=70)和开腹PANP手术(O-PANP组,n=50),采用国际勃起功能问卷表-5(IIEF-5)分别于术后3～6个月、6～12个月、12～20个月3个时段对男性患者性功能进行随访,评估2种手术方式对男性患者性功能的影响。结果 120例均顺利完成手术。术后随访1年以上90例:L-PANP组50例,O-PANP组40例。随访期内,L-PANP组和O-PANP组各有3例和4例术后1年内复发、转移,各有2例死亡,其余均健在。术后第1时段性功能(勃起及射精功能)分级,L-PANP组的Ⅰ型(完全保留骨盆自主神经)及Ⅱ型术式(切除一侧或双侧骶前神经丛,保留双侧盆神经丛)优于O-PANP组同型术式患者(Z=-2.207,P=0.027;Z=-2.207,P=0.027;Z=-2.203,P=0.042;Z=-2.226,P=0.026),但2组的Ⅲ型术式(切除一侧或双侧骶前神经丛,保留一侧盆神经丛)无统计学差异(Z=-1.656,P=0.095;Z=-1.163,P=0.245)。第2、3时段,L-PANP组各型术式患者的性功能分级与O-PANP同型术式对比无统计学差异(均P>0.05)。L-PANP组和O-PANP组1年生存率分别为97.1%(68/70)和96.0%(48/50),无统计学差异(Z=-0.184,P=0.854)。术后1年的盆腔局部复发率分别为4.3%(3/70)和8.0%(4/50),无统计学差异(Z=-0.457,P=0.647)。结论 L-PANP在不增加局部复发的前提下,对男性患者性功能的保护是可行的,且短期内优于O-PANP。

Objective To evaluate the protection of sexual function after laparoscopic radical resection with pelvic autonomic nerve preservation （PANP） for rectal cancer in male patients. Methods Totally 120 male patients with middle or low rectal cancer who were receiving surgery during September 2008 to August 2010 were divided into two groups： laparoscopic PANP （L-PANP） , n = 70 and open PANP （O-PANP）, n = 50. IIEF-5 was used to evaluate the sexual function of the patients at 3 -6 months, 6 - 12 months, and 12 -20 months postoperation respectively. And the results of the two groups were compared to determine the effect of the operations on the sexual function of male patients. Results The operations were completed in all the 120 patients, 90 of them achieved a follow-up for over 1 year （50 in the L-PANP group, and the other 40 in the O-PANP group）. During the follow-up, 3 in the L-PANP and 4 in the O-PANP showed recurrence or metastasis, in each of the groups, there were two patients died. At 3 - 6 months, the patients who received subtypes I （with the pelvic autonomic nerve preserved totally） and II （with the unilateral or bilateral anterior sacral plexus reseeted and the bilateral pelvic plexus preserved） in the L-PANP group had better sexual （ erectile and ejaculation） function than those who underwent the same subtypes of surgery in the O-PANP group （ Z = - 2. 207, P = 0. 027 ; Z = - 2. 207, P = 0. 027 ; Z = - 2. 203, P = 0. 042 ; Z = - 2. 226, P = 0. 026） , but such difference was not noticed in those who received subtype Ⅲ surgery （with the unilateral or bilateral anterior sacral plexus rcsected and the unilateral pelvic plexus preserved） between the two groups （Z= -1.656, P=0.095; Z= - 1. 163, P=0.245）. At 6- 12 and 12 -21） months, however, no matter what subtype of surgery the patients received, there were no significant difference was noticed in the sexual function between the two groups （all P 〉0. 05）. The survival rates of L-PANP and O-PANP groups was 97. 1% （68/70） and 96.0% （48/50） respectively （Z = -0. 184, P =0. 854）. One-year local pelvic recurrence rate of the two groups was 4.3% （3/70） and 8.0% （4/50）, respectively （Z = -0. 457, P = 0. 647 ）. Conclusion As long as it does not increase the rate of local recurrence, L-PANP is feasible for preservation of sexual function in male patients, and it is superior to O-PANP in short-term outcomes.