保留盆腔自主神经的腹腔镜全直肠系膜切除术对女性直肠癌患者术后复发及排尿和性生活质量的影响

Influence of laparoscopic total mesorectal excision with pelvic autonomic nerve preservation on postoperative recurrence,urination and quality of sexual life in female patients with rectal cancer

目的探讨保留盆腔自主神经的腹腔镜全直肠系膜切除术(TME)对女性直肠癌患者术后复发、排尿功能和性生活质量的影响。方法选择2017年10月至2020年1月中国人民解放军南部战区总医院收治的150例女性直肠癌患者为研究对象,患者均行腹腔镜TME治疗,根据术中盆腔自主神经是否完整保留将患者分为观察组(n=90)和对照组(n=60)。观察组患者术中完整保留盆腔自主神经,对照组患者术中盆腔自主神经不同程度受损。观察2组患者术后尿管拔除时间及术后2周最大尿流率、膀胱残余尿量、排尿功能障碍发生率;术后6个月采用女性性功能指数(FSFI)评分评估患者性生活质量;2组患者术后随访1 a,统计复发率、远处转移率和病死率。结果观察组患者术后尿管拔除时间显著短于对照组,术后2周最大尿流率显著高于对照组,膀胱残余尿量显著少于对照组(P<0.05)。术后2周,观察组和对照组患者排尿功能障碍发生率分别为6.67%(6/90)、18.33%(11/60),观察组患者排尿功能障碍发生率显著低于对照组(χ^(2)=4.876,P<0.05)。术后6个月,观察组患者性欲望、性唤起、阴道润滑、性高潮、性满意度、性交痛等评分均显著高于对照组(P<0.05)。术后1 a,观察组患者复发率、远处转移率和病死率分别为3.33%(3/90)、2.22%(2/90)、2.22%(2/90),对照组患者复发率、远处转移率和病死率分别为3.33%(2/60)、3.33%(2/60)、1.67%(1/60);2组患者的复发率、远处转移率、病死率比较差异无统计学意义(χ^(2)=0.216、0.011、0.128,P>0.05)。结论保留盆腔自主神经对TME术后直肠癌患者的排尿功能及性生活质量具有积极作用,在TME过程中应加强对盆腔自主神经的保护,减少盆腔自主神经损伤,以最大程度地减轻对患者术后排尿功能和性生活质量的不良影响。

Objective To investigate the influence of laparoscopic total mesorectal excision(TME)with pelvic autonomic nerve preservation on postoperative recurrence,urination and quality of sexual life in female patients with rectal cancer.Methods A total of 150 female patients with rectal cancer admitted to the General Hospital of Southern Theater of Chinese People′s Liberation Army from October 2017 to January 2020 were selected as the research subjects.All patients underwent laparoscopic TME,and the patients were divided into the observation group(n=90)and control group(n=60).The pelvic autonomic nerves of patients in the observation group were completely preserved,while the pelvic autonomic nerves of patients in the control group were damaged in varying degrees.The postoperative urinary catheter removal time,maximum urinary flow rate,bladder residual urine volume and the incidence of urinary dysfunction at two weeks after operation were observed in the two groups.The quality of sexual life of patients was evaluated by female sexual function index(FSFI)at 6 months after operation.The patients in the two groups were followed up for one year,and the recurrence rate,distant metastasis rate and fatality rate were counted.Results The postoperative urinary catheter removal time of patients in the observation group was significantly shorter than that in the control group,the maximum urinary flow rate at two weeks after operation was significantly higher than that in the control group,and the bladder residual urine volume was significantly lower than that in the control group(P<0.05).Two weeks after operation,the incidence of urinary dysfunction of patients in the observation group and the control group was 6.67%(6/90)and 18.33%(11/60),respectively;and the incidence of urinary dysfunction in the observation group was significantly lower than that in the control group(χ^(2)=4.876,P<0.05).Six months after operation,the scores of sexual desire,sexual arousal,vaginal lubrication,orgasm,sexual satisfaction and algopareunia of patients in the observation group were significantly higher than those in the control group(P<0.05).One year after operation,the recurrence rate,distant metastasis rate and fatality rate of patients in the observation group were 3.33%(3/90),2.22%(2/90)and 2.22%(2/90),respectively;while the recurrence rate,distant metastasis rate and fatality rate of patients in the control group were 3.33%(2/60),3.33%(2/60)and 1.67%(1/60),respectively.There was no significant difference in the recurrence rate,distant metastasis rate and fatality rate of patients between the two groups(χ^(2)=0.216,0.011,0.128;P>0.05).Conclusion Preservation of pelvic autonomic nerves has a positive effect on urination function and quality of sexual life of patients with rectal cancer after TME.During TME,the protection of pelvic autonomic nerves should be strengthened to reduce pelvic autonomic nerve damage,so as to minimize the adverse effects on postoperative urinary function and sexual life quality of patients.