直肠癌手术中保留盆腔自主神经的意义  

Autonomic nerve preserving radical operation for rectal cancer patients

作　　者：梁德森[1] 姜涛[2] 张铁民[2] 吕海涛[2] 田茂霖[2] 

机构地区：[1]华中科技大学同济医学院同济医院普外科,武汉430022 [2]哈尔滨医科大学附属第一临床医学院普外科

出　　处：《中华普通外科杂志》2006年第7期511-513,共3页Chinese Journal of General Surgery

摘　　要：目的探讨中下段直肠癌行保留自主神经的肿瘤根治术(pelvic automatic nerve preservation,PANP)对男性排尿和性功能的影响。方法共118例男性直肠癌患者接受保留自主神经的直肠癌根治术,其中:Dukes A期62例完全保留自主神经;B期49例保留一侧或两侧自主神经; C期7例只保存S3、4自主神经。对照组118例则行传统的直肠癌根治手术,其Dukes分期情况与PANP组相同。结果术后PANP组排尿功能分级为:A期:O级59例,Ⅰ级3例,Ⅱ级无;B期:O级40例,Ⅰ级9例,Ⅱ级无;C期:O级4例,Ⅰ级2例,Ⅱ级1例。性功能分为:A期:O级53例,Ⅰ级6例,Ⅱ级3例;B期:O级6例,Ⅰ级37例,Ⅱ级6例;C期:O级1例,Ⅰ级4例,Ⅱ级2例。与对照组相比A期、B期患者在排尿功能和性功能方面的差异均有统计学意义(P<0．05),C期患者在性功能方面有差异(P<0．05),而排尿功能与对照组无差别(P>0．05)。PANP组与对照组两组病例于根治术后均随访1-5年,局部复发率分别为8．5％(10／118)和6．8％(8／118)。两组比较差异无统计学意义(t=0．49,P>0．05)。结论保留自主神经的直肠癌根治术与传统根治术相比,肿瘤局部复发率相似,而患者的生存质量较高。Objective To evaluate automatic nerve preserving operation （ANPO） for rectal cancer in the protection of postoperative urinary and male sexual functions. Methods Sixty-two Dukes A cases underwent bilateral ANPO, 49 Dukes B cases underwent bilateral or unilateral ANPO, S3 and S4 were preserved for 7 Dukes C cases. Traditional radical operation served as control in other 118 cases. Results postoperative urinary function was： stage O in 59 cases, stag Ⅰ in 3 cases, stage Ⅰ in no case for Dukes A patients. Stage O in 40 cases, stage Ⅰ in 9 cases, stage Ⅱ in no case for Dukes B patients, and stage O in 4 cases, stage Ⅰ in 2 cases,stage Ⅱ in 1 case for Dukes C patients. Sexual function was： Stage O in 53 cases, stag Ⅰ in 6 cases, stage Ⅱ in 3 cases for Dukes A. stage O in 6 cases, stage Ⅰ in 37 cases, stag Ⅱ in 6 cases for Dukes B, and stage O in 1 case, stage Ⅰ in 4 cases, stage Ⅱ in 2 cases for Dukes C. The postoperative local tumor recurrence rate was 8.5% in PANP cases and 6. 8% in control group respectively （ P 〉 0. 05 ）. Conclusion Compared with control group patients undergoing PANP enjoy higher postoperative quality of life without increasing local recurrence.

关 键 词：直肠肿瘤 性功能障碍 排尿障碍 盆腔自主神经 

分 类 号：R735.37[医药卫生—肿瘤] R735.34[医药卫生—临床医学]