青年男性直肠癌患者Mile’s术后性功能变化分析

Analysis of sexual dysfunction after Mile's operation in young male patients

目的：通过对因直肠癌行腹会阴联合直肠癌根治术（Mile’s手术）患者术后性功能调查分析,了解Mile’s手术对性功能的影响,提高患者术后性生活质量。方法：因直肠癌行Mile’s手术患者86例,分别对患者术后3个月（第1次）及术后6个月（第2次）进行重复问卷式调查,包括焦虑自评量表（SAS）、性功能障碍采用勃起功能国际指数问卷（IIEF）调查,进一步了解Mile’s术后性功能障碍的因素,找出其中的相关性。结果：调查86例患者,回收有效问卷82份。在有效的82问卷中,第1次和第2次均存在着不同程度的焦虑。第1次SAS评分40~55分者26例（31.71%）vs 42例（51.22%）,56~66分者38例（46.34%）vs21例（25.61%）,〉67分者18例（21.95%）vs 9例（10.97%）。所有患者均有性欲障碍及性满意度下降,两次调查中均无性生活者19例（23.17%）;在有性生活的63例（66.83%）中,第1次与第2次调查发现勃起功能障碍34例（53.96%）vs 26例（41.27%）;插入障碍18例（28.57%）vs 6例（9.52%）;射精障碍15例（23.81%）vs 10例（15.87%）;早泄33例（52.38%）vs 23例;性欲低下38例（60.32%）vs 16例（25.40%）。两次SAS测评程度与性功能障碍相关性分析,r=1.052和r=1.17,P〈0.05,均提示呈正相关;两次性功能障碍发生率比较,第2次较第1次调查时性功能障碍发生率有所下降（χ2=10.11,P〈0.05）,有统计学意义。结论：直肠癌Mile’s手术及术后心理障碍（焦虑、抑郁、社交障碍）是导致患者术后性功能障碍的主要因素,术中注意神经血管等保护及围术期加强对患者康复指导有重要临床意义。

Objectives： To analyze the sexual function in young male patients with rectal carcinoma after Mile＇s surgery, in order to improve the sexual function. Methods： Questionnaires were administered to the 86 young male patients after rectal Mile＇ s surgery at the 3＇d month and 6＇h month respectively, including the Self - Rat- ing Anxiety Scale （SAS） and the International Index of Erectile Function questionnaire （IIEF） to understand the risk factors for their sexual dysfunction. All the questions were designed to understand the factors of sexual dysfunc- tion and the relationships among them. Results ： A total of 82 valid questionnaires were collected. All the 82 young male patients had varying degrees of anxiety in the two surveys. According to the SAS score, there were 26 （31.71%） cases reporting mild anxiety in the first survey versus 42 （51.22%） cases in second survey, 38 （46. 34% ） cases showing moderate anxiety versus 21 （25.61%）, and 18 （21.95%） cases indicating severe anxi- ety versus 9 （10. 97% ） respectively. All patients had sexual desire disorder and decreased sexual satisfaction： 34 （53.96%） cases in the first survey showed erectile dysfunction versus 26 （41.27%） in the second survey; 18 （28.57%） cases had insertion obstacle vs. 23 （36.51%） cases in the second survey; and 38 （60. 32% ） cases suffered from sexual desire decreased vs. 16 （25.4%） cases in the second survey. The sexual dysfunction presen- ted better postoperative at the 6＇s month than 3＇d month （~2 = 10. 11, P 〈 0.05 ）, and the SAS evaluation was nega- tively correlated with sexual dysfunction both at postoperative 6＇h month and 3~ month （ r = 1. 052 and r = 1.17, P 〈 0. 05）. The incidence of ED in the second survey decreased compared with the first survey, with statically signifi- cant difference （~2 = 10. 11, P 〈 0. 05）. Conclusions： Operation injury and postoperative psychological obstacles （ such as anxiety, depression, and social intercourse disorders） are main factors leading to sexual dysfunction. It is of clinical significance to pay more attention to intraoperative neurovascular protection and give patients suitable re- habilitation guidance.