盆腔自主神经监测对腹腔镜辅助中低位直肠癌根治术中男性患者排尿功能保护作用的研究

Protective effect of pelvic autonomic nerve monitoring on urinary function in male patients undergoing laparoscope-assisted radical resection for middle and low rectal cancer

背景中低位直肠癌由于肿瘤位置较深,容易出现术中盆腔自主神经损伤从而导致患者术后出现排尿功能障碍,寻找降低术中自主神经损伤的方法至关重要。目的探讨术中盆腔自主神经监测对男性患者排尿功能的保护作用,及其降低术中盆腔自主神经损伤发生率的应用价值。方法回顾性分析2017年5月—2019年5月就诊于解放军总医院第一医学中心并接受腹腔镜辅助中低位直肠癌根治术的男性患者临床资料,根据是否行术中盆腔自主神经监测分为监测组和对照组。共纳入患者81例,其中监测组41例(双侧成功监测组31例,单侧成功监测组10例),对照组40例。比较患者围术期指标以及手术前后排尿功能变化。结果3组患者的年龄、肿瘤T分期、N分期、肿瘤直径、分化程度、肿瘤距肛门距离、手术时间、术中出血量、术式等指标差异无统计学意义(P>0.05)。双侧监测组和单侧监测组术后留置导尿管时间均小于对照组[(59.81±34.67)h和(84.50±25.43)h vs(115.73±50.53)h,P<0.05]。双侧监测组和单侧监测组的国际前列腺症状评分(international prostate symptom score,IPSS)术后1个月和术后1年均优于对照组[M(IQR):5.0(2.0~8.0)和4.0(1.3~6.8)vs6.0(1.0~11.0),P均<0.05;3.0(1.0~5.0)和3.0(0.5~5.5)vs 4.5(0.5~8.5),P均<0.05]。双侧监测组和单侧监测组术后1个月和术后1年生活质量评分(quality of life scores,QoL)均优于对照组[M(IQR):3.0(2.0~4.0)和2.5(1.3~3.8)vs 3.0(2.0~4.0),P均<0.05;2.0(1.0~3.0)和2.0(0.8~3.3)vs 3.0(2.0~4.0),P均<0.05]。此外,监测组术前和术后1年的IPSS评分和QoL评分差异无统计学意义(P>0.05),而对照组术前和术后1年的IPSS评分和QoL评分差异有统计学意义(P<0.05)。结论腹腔镜辅助中低位直肠癌根治术中应用盆腔自主神经监测对男性患者排尿功能具有保护作用,降低了患者术中盆腔自主神经损伤的风险,改善了患者的生活质量。

Background Due to the deep location of middle and low rectal cancer,intraoperative pelvic autonomic nerve injury is likely to occur,resulting in postoperative urination dysfunction in patients.Therefore,it is very important to find ways to reduce intraoperative autonomic nerve injury.Objective To investigate the protective effect of intraoperative monitoring of pelvic autonomic nerves(IMPAN)on urination function in male patients and its application value in reducing the incidence of intraoperative pelvic autonomic nerve injury.Methods Clinical data about male patients who underwent laparoscopic-assisted radical resection of mid-low rectal cancer at the First Medical Center of Chinese PLA General Hospital from May 2017 to May 2019 were retrospectively analyzed.The patients were divided into surveillance group and control group according to whether they underwent IMPAN or not.A total of 81 patients were enrolled,including 41 cases in the monitoring group(31 in the bilateral successful monitoring group and 10 in the unilateral successful monitoring group)and 40 cases in the control group.The changes of urination function before and after surgery were compared by comparing the perioperative data and urination function related factors of the three groups.Results There were no significant differences in age,tumor category,lymphatic metastasis,diameter of tumor,degree of differentiation,distance from tumor to anus,operation time,intraoperative blood loss and types of operation among the three groups(P>0.05).The time of indwelling catheter in bilateral monitoring group and unilateral monitoring group were shorter than that in control group([59.81±34.67]h,[84.50±25.43]h vs[115.73±50.53]h,P<0.05).The International prostate symptom score(IPSS)of the bilateral monitoring group and the unilateral monitoring group was better than that of the control group at 1 month and 1 year after surgery(5.0[2.0-8.0],4.0[1.3-6.8]vs 6.0[1.0-11.0],P<0.05;3.0[1.0-5.0],3[0.5-5.5]vs 4.5[0.5-8.5],P<0.05).The quality of life scores(QoL)of the bilateral monitoring group and the unilateral monitoring group at 1 month and 1 year after surgery were better than those of the control group(3.0[2.0-4.0],2.5[1.3-3.8]vs 3.0[2.0-4.0],P<0.05;2.0[1.0-3.0],2[0.8-3.3]vs 3.0[2.0-4.0],P<0.05).In addition,there was no significant difference in the IPSS score and QoL score before and 1 year after operation in the monitoring group(P>0.05),while there was significant difference in the IPSS score and QoL score before and 1 year after operation in the control group(P<0.05).Conclusion The application of IMPAN in laparoscopic-assisted radical resection of mid-low rectal cancer can protect the urination function of male patients,reduce the risk of intraoperative pelvic autonomic nerve injury,and improve the quality of life of patients.