[1]宋世谦.保留盆腔自主神经直肠癌全系膜切除术治疗男性中低位直肠癌疗效观察[J].新乡医学院学报,2019,36(6):574-577.[doi:10.7683/xxyxyxb.2019.06.019]
　SONG Shi-qian.Efficacy of pelvic autonomic nerve preservation in the treatment of middle and low rectal cancer in male patients undergoing total mesorectal resection[J].Journal of Xinxiang Medical University,2019,36(6):574-577.[doi:10.7683/xxyxyxb.2019.06.019]
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保留盆腔自主神经直肠癌全系膜切除术治疗男性中低位直肠癌疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
36
期数:
2019年6
页码:
574-577
栏目:
临床研究
出版日期:
2019-06-05

文章信息/Info

Title:
Efficacy of pelvic autonomic nerve preservation in the treatment of middle and low rectal cancer in male patients undergoing total mesorectal resection
作者:
宋世谦
（卢氏县第三人民医院普外科，河南　卢氏　472200）
Author(s):
SONG Shi-qian
（Department of General Surgery，the Third People′s Hospital of Lushi County，Lushi 472200，Henan Province，China）
关键词:
直肠癌全系膜切除术; 盆腔自主神经; 性功能; 排尿功能
Keywords:
total mesorectal excision of rectal cancer; pelvic autonomic nerve; sexual function; micturition function
分类号:
R735.3+7
DOI:
10.7683/xxyxyxb.2019.06.019
文献标志码:
A
摘要:
目的　探讨直肠癌全系膜切除术中保留盆腔自主神经治疗男性中低位直肠癌的临床效果及其对患者性功能和排尿功能的影响。方法　将2008年1月至2015年1月卢氏县第三人民医院收治的102例男性中低位直肠癌患者分为对照组和观察组，每组51例。2组患者均予以直肠癌全系膜切除术，观察组患者在术中保留盆腔自主神经，对照组患者术中不保留盆腔自主神经。观察2组患者的术中出血量、手术时间、拔胃管时间、拔尿管时间、拔引流管时间、排气时间、下床活动时间、术后住院时间及术后并发症发生情况；比较2组患者术前及术后7 d残余尿量、最大尿流率、最大排尿压、逼尿肌收缩压；采用国际勃起功能指数-5（IIEF-5）问卷调查表、射精功能分级标准评估2组患者术前及术后6个月性功能情况，并比较2组患者术后3 a生存率。结果　2组患者术中出血量、手术时间、拔胃管时间、拔引流管时间比较差异无统计学意义（P>0.05）。观察组患者拔尿管时间、排气时间、下床活动时间及术后住院时间均显著短于对照组（P<0.05）。对照组和观察组患者术后并发症发生率分别为11.8%（6/51）和8.8%（5/51）；2组患者术后并发症发生率比较差异无统计学意义（χ2=0.103，P>0.05）。2组患者术前残余尿量、最大尿流率、最大排尿压、逼尿肌收缩压比较差异无统计学意义（P>0.05）。2组患者术后7 d残余尿量均显著高于术前（P<0.05），最大尿流率、最大排尿压、逼尿肌收缩压显著低于术前（P<0.05）。观察组患者术后7 d残余尿量显著低于对照组（P<0.05），最大尿流率、最大排尿压、逼尿肌收缩压显著高于对照组（P<0.05）。2组患者术前IIEF-5评分比较差异无统计学意义（P>0.05）；2组患者术后6个月IIEF-5评分显著低于术前（P<0.05）；观察组患者术后6个月IIEF-5评分显著高于对照组（P<0.05）。术后6个月，对照组和观察组患者射精功能障碍发生率分别为41.2%（21/51）和13.7%（7/51）；观察组患者射精功能障碍发生率显著低于对照组（χ2=9.651，P<0.01）。对照组和观察组患者术后 3 a 生存率分别为72.5%（37/51）和90.2%（46/51）；观察组患者术后3 a生存率显著高于对照组（χ2=5.246，P<0.01）。结论　直肠癌全系膜切除术中保留盆腔自主神经治疗男性中低位直肠癌患者，可促进患者术后恢复，有效减轻术后排尿功能障碍及性功能障碍，提高3 a生存率。
Abstract:
Objective　To investigate the clinical effect of pelvic autonomic nerve reservation in total mesocrectal resection for rectal cancer in male patients with middle and low rectal cancer and its effect on sexual function and urinary function.Methods　A total of 102 male patients with middle and low rectal cancer were chosen in the Third People′s Hospital of Lushi County from January 2008 to January 2015 were divided into control group and observation group，with 51 cases in each group.Patients in both groups were treated with total mesocrectal resection for rectal cancer，and pelvic autonomic nerve was retained in the observation group，while pelvic autonomic nerve was not retained in the control group.The intraoperative blood loss，operation time，gastric tube extubation time，urinary tube extubation time，drainage tube extubation time，exhaust time，time to get out of bed，postoperative hospitalization time and postoperative complications were observed in the two groups.The residual urine volume，maximum urine flow rate，maximum voiding pressure，and detrusor systolic pressure were compared between the two groups before and at seven days after surgery.The sexual function of the patients in the two groups was evaluated by international erectile function index-5 （IIEF-5） questionnaire and ejaculation function grading standard before and at six months after surgery，and the 3-year survival rate after surgery was compared between the two groups.Results　There was no significant difference in the intraoperative blood loss，operation time，gastric tube extubation time and drainage tube extubation time between the two groups （P>0.05）.The time of catheter extubation，time of exhaust，time of getting out of bed and postoperative hospitalization time in the observation group were significantly shorter than those in the control group （P<0.05）.The incidence of postoperative complications in the control group and the observation group was 11.8% （6/51） and 8.8% （5/51），respectively.There was no significant difference in the incidence of postoperative complications between the two groups （χ2=0.103，P>0.05）.There was no significant difference in the preoperative residual urine volume，maximum urine flow rate，maximum voiding pressure，and detrusor systolic pressure between the two groups （P>0.05）.The residual urine volume at seven days after surgery in both groups was significantly higher than that before surgery （P<0.05）.and the maximum urine flow rate，maximum voiding pressure，and detrusor systolic pressure were significantly lower than that before surgery （P<0.05）.The residual urine volume of the observation group was significantly lower than that of the control group at seven days after surgery （P<0.05），and the maximum urine flow rate，maximum voiding pressure，and detrusor systolic pressure were significantly higher than those of the control group （P<0.05）.There was no significant difference in the preoperative IIEF-5 score between the two groups （P>0.05）.The IIEF-5 score of the two groups at six months after surgery was significantly lower than that before surgery （P<0.05）.The IIEF-5 score of the observation group was significantly higher than that of the control group at six months after surgery （P<0.05）.At six months after surgery，the ejaculatory dysfunction rate was 41.2% （21/51） and 13.7% （7/51） in the control group and the observation group；the incidence of the ejaculation dysfunction in the observation group was significantly lower than that in the control group （χ2=9.651，P<0.01）.The survival rates of patients in the control group and the observation group were 72.5% （37/51） and 90.2% （46/51）.The 3-year survival rate after surgery of the observation group was significantly higher than that of the control group （P<0.05）.Conclusion　Preserving pelvic autonomic nerve in total mesorectal cancer resection for male patients with middle and low rectal cancer can promote postoperative recovery and effectively reduce postoperative urinary dysfunction and sexual dysfunction，and improve the quality of life and 3-year survival rate after surgery of patients.

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更新日期/Last Update: 2019-06-05