直肠癌患者RTME联合PANP术后排尿功能障碍的影响因素研究

Study on influencing factors of voiding dysfunction after RTME combined with PANP in patients with rectal cancer

[目的]初步探讨机器人全直肠系膜切除术(RTME)联合盆腔自主神经保护(PANP)对直肠癌患者术后排尿功能的影响,并分析排尿功能障碍的危险因素。[方法]选取直肠癌患者106例,根据不同的手术方式将患者分为RTME+PANP组(机器人组)、腹腔镜直肠癌全系膜切除术(LTME)+PANP组(腹腔镜组),对比2组患者的围手术期指标、术后排尿功能。对排尿障碍的相关因素进行单因素和多因素Logistics回归分析。[结果]机器人组的术中出血量明显比腹腔镜组少,但手术时间更长(P<0.05);机器人组的自由尿流率明显更快,残余尿量更少,拔除尿管时间更短,术后6个月的排尿障碍发生率更低,IPSS评分更低(P<0.01)。单因素分析结果示男性、糖尿病患者、LTME+PANP手术与患者术后发生排尿功能障碍相关(P<0.05);多因素Logistics回归分析结果示男性(OR=2.878,95%CI:1.528~5.420)、糖尿病患者(OR=3.007,95%CI:1.240~7.293)、LTME+PANP的手术方式(OR=2.959,95%CI:1.220~7.177)是独立危险因素。[结论]在机器人系统的辅助下行RTME联合PANP能降低直肠癌患者术后排尿功能障碍的发生率;此外,男性、糖尿病患者、手术方式为LTME+PANP是术后发生排尿功能障碍的独立危险因素。

[Objective]To investigate the effect of robotic total mesorectal excision(RTME)combined with pelvic autonomic neuroprotection(PANP)on postoperative micturition function in patients with rectal cancer,and to analyze the risk factors of voiding dysfunction.[Methods]From April 2018to January 2021,106patients with rectal cancer were divided into RTME+PANP group(robot group)and LTME+PANP group(laparoscopy group).The perioperative indexesand postoperative voiding function of the two groups were compared.Univariate and multivariate Logistics regression analysis was used to analyze the related factors of dysuria.[Results]The amount of intraoperative bleeding in the robot group was significantly less than that in the laparoscopy group,but the operation time was longer(P<0.05).The free urine flow rate was faster,the residual urine volume was less,the time of catheter removal was shorter,the incidence of voiding dysfunction and IPSS score was lower at 6months after operation in the robot group(P<0.01).The results of univariate analysis showed that male,diabetic patients and LTME+PANP surgery were associated with postoperative voiding dysfunction.The results of multivariate Logistics regression analysis showed that male(OR=2.878,95%CI:1.528-5.420),diabetic(OR=3.007,95%CI:1.240-7.293)and operation mode LTME+PANP(OR=2.959,95%CI:1.220-7.177)were independent risk factor.[Conclusion]Robot-assisted RTME combined with PANP can reduce the incidence of postoperative voiding function in patients with rectal cancer.In addition,male,diabetic patients and LTME+PANP are independent risk factors for postoperative voiding dysfunction.