腹腔镜与开腹保留盆腔自主神经直肠癌根治术对男性排尿功能的影响

Male urinary function after laparoscopic or open radical resection for rectal cancer with pelvic autonomic nerve preservation

目的评价腹腔镜与开腹保留盆腔自主神经(PANP)直肠癌根治术对男性患者术后排尿功能的影响。方法回顾经手术治疗的112例男性直肠癌患者临床资料,其中行腹腔镜PANP直肠癌根治术60例(研究组),行开腹PANP直肠癌根治术52例(对照组)。比较两组患者尿管拔除时间、排尿功能障碍发生率、尿流动力学检查等,评估两种手术方式对患者排尿功能的影响。结果研究组和对照组术后尿管拔除时间分别为(2.5±0.5)d和(4.0±0.7)d(P<0.05),术后2周发生排尿功能障碍分别为2例(3.3%)和6例(11.5%)(P<0.05)。术后2周尿动力学检查:研究组和对照组排尿量分别为(325.4±26.7)ml和(278.5±19.8)ml(P<0.05),最大尿流率分别为(27.8±2.9)ml/s和(20.6±3.1)ml/s(P<0.05),残尿量分别为(15.4±2.7)ml和(28.5±3.4)ml(P<0.05)。术后3个月比较两组患者的排尿功能和尿动力学指标,研究组虽优于对照组,但差异均无统计学意义(均P>0.05)。结论直肠癌根治手术注重PANP可更好保护男性患者的排尿功能,腹腔镜较开腹手术效果更好。

Objective To evaluate the male urinary function after laparoscopic or open radical resection for rectal cancer with pelvic autonomic nerve preservation（PANP）. Methods One hundred and twelve male patients with rectal cancer admitted during November 2015 to December 2016 were enrolled in the study, including 60 cases undergoing laparoscopic radical resection with PANP（study group） and 52 undergoing open surgery with PANP（control group）. The time of urinary catheter removal, urinary dysfunction rate and urodynamics were compared between two groups. Results The time of urinary catheter removal in study group was shorter than that of control group（2.5±0.5 d vs. 4.0±0.7 d, P0.05）. The urinary dysfunction rate at 2 weeks after surgery in study group was lower than that of control group（3.3% vs. 11.5%, P0.05）. Urodynamic study showed that there were significant differences in voided volume [（325.4±26.7 vs. 278.5±19.8） ml], maximal flow rate [（27.8±2.9 vs. 20.6±3.1） ml/s] and residual urine volume[（15.4±2.7 vs. 28.5±3.4）ml] 2 weeks after surgery between two groups（all P0.05）, however, there was no significant difference at 3 months after surgery（P 0.05）. Conclusion Radical resection of rectal cancer with PANP can protect the urinary function of male patients, and laparoscopic surgery shows a superiority as compared with open surgery.