腹腔镜直肠癌根治术中保护盆腔植物神经的应用

Protection of laparoscopic radical resection of rectal carcinoma for pelvic autonomic nerve

目的探讨腹腔镜直肠癌根治术保留盆腔植物神经对男性患者术后排尿及性功能的影响。方法回顾分析2007年1月~2012年6月160例男性直肠癌患者施行腹腔镜手术的临床资料,总结其对患者术后排尿及性功能的影响,其中保留盆腔植物神经组78例,未保留组82例。结果两组均顺利完成手术。其中保留植物神经组72例获得随访,未保留组75例获得随访。5年存活率保留植物神经组为54.2%（39/72）,未保留组为53.3%（40/75）,两组差异无显著性（P〉0.05）。保留植物神经组术后排尿功能障碍率7.7%,勃起功能障碍率9.0%,射精功能障碍率7.7%,未保留组分别为24.4%、25.6%及25.6%,两组差异均有显著性（P〈0.05）。结论腹腔镜直肠癌根治术保留盆腔自主神经可有效降低男性患者术后排尿功能及性功能障碍的发生率,5年生存率无明显影响,但明显提高了患者的生活质量。

【Objectives】To evaluate the urinary and sexual functions after pelvic autonomic never preserving in laparoscopic radical resection for rectal cancer in male patients.【Methods】Retrospective analysis was made on clinical data of 160 male patients in laparoscopic radical resection for rectal cancer during January 2007 to June 2012.They were divided into two groups（pelvic autonomic nerve preservation group,n =78;the non-preservation group,n =82）.【Results】All of the cases were completed successfully.For the rate of 5-year survival,the pelvic autonomic nerve preservation group was 54.2%（39/72）,and the non-preservation group 53.3%（40/75）（P 0.05）.The urinary disorder rates,effective disorder rates and ejaculation disorder rates of pelvic autonomic nerve preservation group 7.7%,9.0% and 7.7%,while values of open group were 24.4%,25.6%,and 25.6%.The difference between them was statistically significant（P 0.05）.【Conclusions】The laparoscopic radical resection with pelvic autonomic nerve preservation can effectively reduce the incidence of urinary dysfunction and sexual dysfunction after operation,and improve patient quality of life after operation.