腹腔镜全直肠系膜切除术中保留盆腔自主神经对术后男性患者性功能的影响

The effect of laparoscopic total mesorectal excision and pelvic autonomic nerve preservation on postoperative sexual functions in male patients

目的:对比腹腔镜及开腹全直肠系膜切除术中保留盆腔自主神经对男性患者术后性功能的影响。方法:回顾分析2011年6月至2015年6月92例直肠癌根治术(均行Dixon术)患者的临床资料,其中45例行腹腔镜下保留盆腔自主神经的全直肠系膜切除术(腹腔镜组),47例开腹行保留盆腔自主神经的全直肠系膜切除术(开腹组),对比两组患者术后勃起功能障碍、射精功能障碍发生率及术后1年盆腔局部复发情况。结果:术后1、3、6个月,开腹组勃起功能障碍、射精功能障碍发生率明显高于腹腔镜组,差异有统计学意义(P<0.05);术后12个月后,两组差异无统计学意义(P>0.05)。1年后两组患者盆腔局部复发率差异无统计学意义(P>0.05)。结论:腹腔镜全直肠系膜切除术中保留盆腔自主神经在达到与开腹手术相同的根治效果的基础上,术后早期(6个月内)患者性功能恢复效果更好,且于术后12个月达到与开腹手术相同的保护患者性功能的效果,明显改善了男性患者的术后生活质量,具有较高的临床应用价值。

Objective： To compare the postoperative sexual functions of male patients who underwent total mesorectal excision and pelvic autonomic nerve preservation by laparoscopy or open surgery. Methods： A retrospective study of 92 cases of radical resection of rectal cancer（ Dixon surgery） in China-Japan Friendship Hospital from Jun. 2011 to Jun. 2015 was done. Patients were divided into2 groups,including 45 cases of laparoscopic total mesorectal excision with pelvic autonomic nerve preservation,and 47 cases of open total mesorectal excision with pelvic autonomic nerve preservation. Postoperative local recurrence of a year in the pelvic region and incidence of erectile dysfunction and ejaculatory dysfunction were compared between the two groups. Results： In 1 month after operation,3months after operation and 6 months after operation,erectile dysfunction,ejaculatory dysfunction incidence of the open group was significantly higher than that of the laparoscopic group（ P〈0. 05）. In 12 months after operation,there was no significant difference between two groups in ejaculatory dysfunction and erectile dysfunction（ P 0. 05）. There was no significant difference between two groups in pelvic local recurrence rate after 1 year（ P 0. 05）. Conclusions： On the basis of same radical cure effect,postoperative sexual function restores better in early period（ within 6 months） by laparoscopic total mesorectal excision with pelvic autonomic nerve preservation. What＇s more,laparoscopic total mesorectal excision with pelvic autonomic nerve preservation can achieve the result that protect the patient＇s sexual function like open operation,has a high clinical application value. Postoperative life quality of male patients improves obviously.