腹腔镜与开腹保留盆腔自主神经的低位直肠癌根治术对男性性功能的影响

Male sexual function after laparosco-pic and laparotomye section in patients with lower rectal cancer

目的:探讨腹腔镜与开腹保留盆腔自主神经(pelvic automatic nerve preservation,PANP)的低位直肠癌根治术对男性患者术后性功能的影响。方法:选取2008年9月至2013年12月分别行腹腔镜PANP手术(n=105)和开腹PANP手术(n=72)的男性直肠癌患者177例,采用勃起及射精功能分级分别对患者术后6、12个月性功能进行随访,评估这两种手术方式对男性患者性功能的影响。结果:腹腔镜组患者术后6、12个月勃起功能障碍的发生率低于开腹组,其射精功能障碍发生率也低于开腹组;两组患者术后6、12个月性功能分级比较,腹腔镜组均优于开腹组(P<0.05)。结论 :腹腔镜PANP低位直肠癌根治术与开腹PANP手术相比,术中能更清晰地显露盆腔植物神经并予以保护,有效减少了术后性功能障碍的发生率。

Objective To investigate the effects of laparoscopic and open resection with pelvic autonomic nerve preservation （PANP） on sexual function of male patients with lower rectal cancer. Methods Total 177 male patients with lower rectal cancer received surgery from September 2008 to December 2013 were enrolled into two groups： the laparoscopic PANP group （n = 105） and the open PANP group （n = 72）. The classifications of erectile and ejaculatory functions were used to evaluate the sexual functions of patients at 6 months and 12 months post-operation, respectively. The effect of different operation on the sexual function of the male patients was compared between the two groups. Results The incidence rates of erectile dysfunction at 6 months and 12 months post-operation in the laparoscopie group were lower than those in the laparotomy group （P 〈 0.05）. The incidence rates of ejaculatory dysfunction at 6 months and 12 months post-operation in the laparoscopic group were also lower than those in the laparotomy group （P 〈 0.05）. Conclusion The laparoscopic resection with PANP in patients with lower rectal cancer can not only clearly reveal pelvic autonomic nerve and effectively protect them, but also reduce the incidence of postoperative sexual dysfunction.