盆腔自主神经保护在腹腔镜直肠癌根治术男性性功能保护中的价值研究

The value of pelvic autonomic nerve plexus in protecting male sexual function in laparoscopic rectal carcinoma radical surgery

目的研究盆腔自主神经保护在腹腔镜直肠癌根治术男性性功能保护中的价值。方法以本院胃肠外科2013年9月至2015年9月收治的99例无盆壁侵犯中低位男性直肠癌患者为研究对象,随机分为观察组(严格盆腔自主神经保护组)与对照组(非严格盆腔自主神经保护组)。术前对两组患者进行射精功能评分以及勃起功能国际问卷(IIEF-5)调查,术后随访1年,比较两组术后3个月、6个月及12个月的性功能情况。结果术前,两组性功能调查结果差异均无统计学意义(P>0.05)。观察组患者术后3个月、6个月及12个月的勃起功能、射精功能均优于对照组,差异均有统计学意义(均P<0.05)。住院期间,两组均无吻合口出血、吻合口狭窄及粘连性肠梗阻病例。观察组肠吻合口漏发生率、切口感染发生率、肺部感染发生率及并发症总发生率之间差异均无统计学意义(均P>0.05)。结论腹腔镜直肠癌根治术中进行盆腔自主神经保护能有效减少盆自主神经丛的损伤,利于保护男性性功能,安全可行。

Objective To study The value of pelvic autonomic nerve plexus protecting male sexual function in laparoscopic rectal carcinoma radical surgery. Methods 99 patients with rectal cancer with no pelvic wall invasion who were admitted to our Department of Gastrointestinal Surgery from September 2013 to September 2015 were recruited as the study objects,and were randomly assigned to treatment group（strict preservation of plexus surgery group） and control group（non-strict preservation of plexus surgery group）. The ejaculatory function score and erectile function questionnaire（IIEF-5） were used to investigate the sexual function of the two groups after 3 months,6 months and 12 months after the operation. The patients were followed up for 1 years after the operation. Results The sexual functional of two groups showed no significant difference before operation（P 〉0.05）. The erectile function and ejaculatory function of the treatment group were better than those of the control group at 3 months,6 months and 12 months after the operation,and the differences were statistically significant（P〈 0.05）. During hospitalization,no anastomotic bleeding,anastomotic stenosis and obstruction were reported in the two groups. There were no significant differences in the incidence of intestinal anastomotic leakage,incision infection,pulmonary infection and the total incidence of complications between the treatment group and the treatment group（all P 〉0.05）. Conclusion The strict preservation of autonomic plexus in laparoscopic radical resection of rectal cancer can effectively reduce the damage of pelvic autonomic nerve plexus,which is beneficial to the protection of sexual function,and is safe and feasible.