保留盆腔自主神经的直肠系膜全切除术对患者术后排尿和性功能的影响  

Urinary and Sexual Functional Results of Total Mesorectal Excision and Autonomic Nerve Plexus-preserving operation for Rectal Cancer

作　　者：陈晓亮[1] 曹虹[1] 熊乐平[1] 

机构地区：[1]江西省人民医院普外科,330006

出　　处：《实用癌症杂志》2004年第5期515-517,共3页The Practical Journal of Cancer

摘　　要：目的　研究保留盆腔自主神经的直肠系膜全切除术后患者的排尿和性功能。方法　将 63例DukesA、B期直肠癌患者随机分为对照组 (2 9例 )和研究组 (3 4例 )。对照组行Miles手术 (13例 ) ,Dixon手术 (16例 ) ;研究组行保留盆腔自主神经的直肠系膜全切除术 ,保留肛门 2 5例 ,未保留肛门 9例。观察比较 2组患者术后自主排尿的情况 ,膀胱残余尿量及性功能。结果　研究组患者术后轻、中、重度排尿障碍的发生率分别为 11.8%、5 .9%和 0 ,明显低于对照组 (2 4.1%、2 0 .7%和 3 .5 % )。研究组中 17例男性患者术后 2例 (11.8% )阴茎不能勃起 ,4例 (2 3 .5 % )不能完成性交及射精 ;17例女性患者术后 1例 (5 .9% )性交时阴道湿润性差 ;7例男、女患者 (2 0 .6% )术后不能体会性高潮。对照组中 15例男性患者术后 11例 (73 .3 % )阴茎不能勃起 ,13例 (86.7% )不能完成性交及射精 ;14例女性患者术后 6例 (4 2 .9% )阴道湿润性差 ;2 5例男、女患者 (86.2 % )术后不能体会性高潮。研究组男、女患者术后性功能障碍发生率显著低于对照组。结论　保留盆腔自主神经的直肠系膜全切除术能较好保留直肠癌患者术后的排尿和性功能。Objective To investigate the urinary and sexual functional results of total mesorectal excision(TME) and automomic nerve plexus-preserving for rectal cancer.Methods 63 cases with Dukes A and B rectal cancer were randomly assigned to receive either Miles’(13 cases) or Dixon’s(16 cases) operation(control group,n=29) or the PANP-preserving TME(study group,n=34).In the study group,anal sphincter was preserved in 25 cases.The urinary and sexual function,the volume of residual urine in bladder were compared between the two groups.Results The incidences of mild,middle and severe morbidity in the urinary function in study group were 11.8%,5.9% and 0,which were much lower than those in control group(24.1%,20.7% and 3.5%).In study group,2 of 17(11.8%) male patients lost function of penis erection,4 of 17(23.5%) male patients couldn’t ejaculate,1 of 17(5.9%) female patients had poor wetness in vagina during sexal intercourse,7 of 34(20.6%) cases couldn’t experience sexual tide.In control grounp,11 of 15(73.3%) male patients lost function of penis erection,13 of 15(86.7%) male patients couldn’t ejaculate,6 of 14(42.9%) female patients had poor wetness in vagina during sexual intercourse,25 of 29(86.2%) couldn’t experience sexual tide.The rate of sexual dysfunction in study group was much lower than that in control group.Conclusion The urinary and sexual function is well preserved by PANP-preserving TME.

关 键 词：直肠肿瘤 盆腔自主神经丛 直肠系膜全切除术 性功能 排尿障碍 

分 类 号：R735.37[医药卫生—肿瘤]