腹腔镜低位直肠癌根治术中保留与不保留Denonvilliers筋膜的对照研究

A comparative study of Denonvilliers fascia retention or not in the laparoscopic radical resection of low rectal cancer

目的探讨腹腔镜低位直肠癌根治术中保留与不保留Denonvilliers筋膜(DVF)对男性患者的术后排尿功能、性功能等的影响。方法选取2018年3月至2020年3月行腹腔镜下低位直肠癌根治术的108例男性患者为研究对象,随机分为两组,每组54例,一组术中切除DVF筋膜(切除组),另一组保留DVF筋膜(保留组)。采用软件SPSS19.0进行统计学分析。围术期指标、尿动力学指标等以均数±标准差(x±s)表示,采用独立t检验;并发症等计数资料采用χ^(2)检验分析;排尿功能分级、性功能分级等级资料采用非参数秩和检验分析;以P<0.05表示差异有统计学意义。结果保留组手术时间明显长于切除组,术中出血量、术中输血例数均少于切除组(P<0.05);保留组患者的最大尿流量、最大逼尿肌收缩压、最大尿道压、膀胱顺应性等均明显大于切除组(P>0.05);保留组排尿功能和射精功能障碍、勃起功能障碍均优于保留组(P<0.05);两组患者并发症发生率差异无统计学意义(P>0.05)。结论男性低位直肠癌患者行腹腔镜下直肠癌根治术中保留DVF筋膜可明显减少术中出血、输血例数,同时显著改善患者术后尿动力学、排尿功能、性功能,安全有效。

Objective To investigate the impact of retaining or not retaining the Denonvilliers fascia(DVF)on the urinary and sexual function of male patients after laparoscopic radical resection of low rectal cancer.Methods The clinical data of 108 male patients who underwent laparoscopic radical resection of low rectal cancer from March 2018 to March 2020 were analyzed retrospectively.and who were randomly divided into the resection group(n=54 cases),and the retention group(n=54 cases),according to the preservation of DVF or not.Statistical analysis were performed by using SPSS19.0 software.The perioperative indexes such as operation time,intraoperative blood loss,length of bowel resection,number of lymph node dissection were expressed as,the difference between groups were examined by using T test.,The complications were examined by usingχ^(2) test,and the grade of urination and sexual function were analyzed by using nonparametric rank sum test,A P value of<0.05 was considered as statistically significant difference.Results The operation time in the retention group was significantly longer than that in the resection group,and the amount of blood loss and intraoperative transfusion were less than those in the resection group respectively(P<0.05).However,there was no significant difference between two groups in terms of the length of resected bowel specimens and the number of harvested lymph nodes(P>0.05).The maximum urine flow,maximum detrusor systolic pressure,maximum urethral pressure and bladder in the retention group were much lower than those in the resection group respectively(P<0.05).The cysts compliance was significantly higher than that in the resection group;the incidence of voiding dysfunction,ejaculation dysfunction and erectile dysfunction were lower than those in the resection group.(P<0.05)There was no significantly difference between the two groups in terms of the incidence of pelvic abscess,anal pain,intestinal obstruction(P>0.05).Conclusion For male patients with low rectal cancer underwent laparoscopic radical resection,retaining the Denonvilliers fascia could significantly reduce blood loss and transfusion,with improved postoperative indexes,urination function,and sexual function,which is safe and effective.