保护盆腔神经的男性直肠癌腹腔镜术后近期康复指标及其与中期性功能的关系

The relationship between the short-term rehabilitation index and the medium-term function of the pelvic nerve in male rectal cancer after laparoscopy

目的探讨保护盆腔神经的男性直肠癌腹腔镜术后近期康复指标及其与中期性功能的关系。方法回顾性分析腹腔镜根治术的直肠癌患者60例。观察组30例术中保留盆腔自主神经;对照组30例均不予保留。对比两组术后血清前白蛋白(PA)、C反应蛋白(CRP)、白细胞计数(WBC)、血皮质醇(Cor)水平。另观察术后6个月时勃起及射精障碍的独立影响因素。结果观察组术后排气时间、术后排便时间、拔尿管时间、下床活动时间、术后住院时间明显短于对照组(P<0.05);观察组术后3 d时血清CRP、WBC、Cor水平明显低于对照组,PA水平明显高于对照组(P<0.05)。勃起功能障碍的独立影响因素为术后3 d时PA及CRP水平(P<0.05);射精功能障碍的独立影响因素为术后3 d时PA水平(P<0.05)。结论腹腔镜手术中保护盆腔神经有助于促进患者术后近期恢复,且近期高PA水平可能是中期性功能的保护机制之一。

Objective To study of short-term rehabilitation index and its relationship with medium-termfunction in male rectal cancer after laparoscopic surgery. Methods A retrospective analysis was made of 60 caseswith rectal cancer who received laparoscopic radical resection in our hospital. In the observation group,the pelvicautonomic nerves were retained in 30 cases,and 30 cases in the control group were not retained. The levels of se-rum prealbumin（PA）,C reactive protein（CRP）,white blood cell count（WBC）and blood cortisol（Cor）werecompared between the 2 groups. The independent influence factors of erectile and ejaculatory disorder were fol-lowed up at 6 months after operation. Results Postoperative exhaust time,defecation time,postoperative extuba-tion time,ambulation time,postoperative hospitalization time in the observation group were significantly shorterthan those in the control group（P〈0.05）. The level of serum CRP,WBC and Cor in the observation group wassignificantly lower than those of the control group at 3 d after operation,and the level of PA was significantly high-er than that of the control group（P〈0.05）.The independent influence factors of erectile dysfunction were the levelof PA and CRP at 3d after operation（P〈0.05）.The independent influence factors of ejaculatory dysfunction werePA level at 3D after operation（P〈0.05）. Conclusion Pelvic nerve protection in laparoscopic surgery is helpfulto promote the postoperative recovery. High PA at short term after operation may be one of the medium-term protec-tion mechanisms for sexual function.