腹腔镜在直肠癌保留盆腔植物神经中的应用  

Clinical Study of the Male Sexual and Urinary Functions after Laparoscopic Colorectal Surgery with Autonomic Nerve Preservation

作　　者：张胜祖[1] 王劲[1] 叶亮[1] 黎柏峰 

机构地区：[1]湖南省株洲市一医院普外科,株洲412000

出　　处：《中国现代手术学杂志》2011年第3期195-197,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨腹腔镜在直肠癌根治手术中保留盆腔植物神经对排尿和性功能的影响。方法不同时期的两组腹腔镜直肠癌根治手术病人,其中非保留盆腔植物神经组43例,保留组173例,回顾性分析两组术后排尿功能及性功能的影响。结果保留组随访156例,平均时间3.5(1～5)年;未保留组随访28例,平均时间6(5～7)年。手术后1、3、5年生存率,保留组与未保留组分别为82.9%vs.77.5%,50.0%vs.53.3%,31.3%vs.30.5%,组间差异无显著性(P>0.05)。5年总局部复发率保留组为12.8%(20/156),未保留组为14.3%(4/28),组间差异无显著性(P>0.05)。术后恢复自行排尿时间未保留组为(5.5±1.7)d,长于保留组的(3.1±1.6)d(P<0.05)。术后半年调查性功能,保留组与未保留组比较有显著性差异,为49.3%(7/150)vs.20.6%(7/34)(P<0.01);肿瘤位于中上段(P<0.05)和Dukes A(P=0.04)、B期(P<0.01)时保留组的性功能保留率更高。结论腹腔镜直肠癌根治术中保留植物神经功能,局部复发率和5年生存率无明显影响,但可明显提高患者的生存质量。Objective To explore the male sexual and urinary functions for colorectal cancer in laparoscopic radical surgery with autonomic nerve preservation.Method Two groups of men were retrospectively analyzed in different periods of laparoscopic surgery,including the autonomic nerve preservation group（study group） of 173 cases,and the non-preservation group（control group） of 43 cases.Results There were 156 cases obtained follow-up in the study group with the average time of 3.5（1～5） years.And in the control group,there were 28 cases got follow-up with average time of 6（5～7） years.There was no difference of the 1,3,5 year＇s survival rate between the study group and the control group,that was 82.9% vs.77.5%,50.0% vs.53.3%,31.3% vs.30.5% respectively（P〉0.05）.There was no significant difference between the two groups in the 5 years of total local recurrence rate,which was 12.8%（20/156） vs 14.3%（4/28）（P〉0.05）.The urethral catheter reservation time was（3.1±1.6） days in the study group,which was much shorter than the（5.5±1.7） days of the control group（P〈0.05）.It showed significant difference between the study group and the control group of the postoperative sexual function 6 months after operation,which was 49.3%（74/150） vs.20.6%（74/150） vs.20.6%（7/34）（P〈0.01）.In interclass comparison,it showed significant sexual retention rate at the superior and middle segments,and Dukes A and B stages.Conclusion The laparoscopic radical surgery with autonomic nerve preservation would not increase the local recurrence rate,nor reduce the 5-year survival rate,but may evidently improve the life quality of male patients.

关 键 词：直肠肿瘤 腹腔镜检查 盆腔植物神经 性功能障碍 排尿障碍 

分 类 号：R735.37[医药卫生—肿瘤]