腹腔镜下乙状结肠癌根治术保留盆腔自主神经的临床研究  

Laparoscopic Pelvic Autonomic Nerve-Preserving Surgery for Sigmoid Colon Cancer

作　　者：吴淼[1] 杨健[1] 刘见[1] 邓小东[1] 郑涛[1] 刘世呈[1] 陈历恒 

机构地区：[1]宜宾市第二人民医院胃肠肛肠疝外科,四川宜宾644000

出　　处：《华西医学》2013年第7期1021-1024,共4页West China Medical Journal

摘　　要：目的探讨腹腔镜下乙状结肠癌根治术保留盆腔自主神经的可行性及对术后泌尿、生殖功能的影响。方法选取2007年8月-2009年7月60例行腹腔镜下乙状结肠癌根治术患者,手术按标准腹腔镜下乙状结肠癌前切除手术方式操作。术后采用问卷调查方式对患者术后泌尿功能、男性勃起功能、女性性功能进行效果评价。生殖泌尿功能评估包含国际前列腺增生评分(IPSS)、国际勃起功能评分量表(IIEF)、女性性功能评估量表(FSFI)。结果 58例患者成功保留自主神经,56例接受术后泌尿、生殖功能测定,置放尿管时间为1～7 d,平均3 d,拔除尿管后排尿功能良好(IPSS 0～7分)57例(95.0%),一般(IPSS 8～14分)2例(3.3%),差(IPSS 15～35分)1例(1.7%),术前、术后IPSS评分差异无统计学意义(P=0.075)。30例男性患者术后,射精良好27例(90.0%),一般2例(6.7%),差1例(3.3%);但是勃起功能测定良好(IIEF 60～75分)28例(93.4%),一般(IIEF 44～59分)1例(3.3%),差(IIEF 5～43分)1例(3.3%),术前、术后IIEF差异无统计学意义。26例女性患者术后性功能评分,良好(FSFI 76～95分)23例(88.5%),一般(FSFI 58～75分)2例(7.7%),差(FSFI 4～57分)1例(3.8%)。盆腔神经保留成功的患者术前、术后差异无统计学意义(P=0.122)。结论多数腹腔镜下乙状结肠癌根治术患者能有效保留盆腔自主神经,且术后能保留泌尿、生殖功能。Objective To evaluate the feasibility of laparoscopic approach in performing the simultaneous pelvic autonomic nerve preservation during standard resection of sigmoid colon cancer.Methods Patients meeting appropriate eligibility criteria were recruited for the present study.The genitourinary function was evaluated on the basis of validated questionnaires including International Prostate Symptom Score（IPSS）,International Index of Erectile Function（IIEF）,and Female Sexual Function Index（FSFI）.Results A total of 60 patients（tumor,node,metastasis system stage I,n=10;stage ？,n=18;stage ？,n=32;male,n=32;female,n=28;age,55.2 ？5.3 years） were operated on with the intent of total preservation of pelvic autonomic nerves and curative resection of sigmoid colon cancer.The patients were prospectively followed for one year.In patients with a successful nerve-preserving surgery（n=58）,56 patients completed the evaluation of urinary function.The median duration for indwelling urine Foley catheter was 3.0 days（range,1.0-7.0 days）.The voiding function after removal of the urine Foley catheter was good（IPSS,0-7） in 57（95%） patients,fair（IPSS,8-14） in 2（6.7%）,and poor（IPSS,15-35） in 1（3.3%）.Before and after nerve-preserving surgery,there were no significant changes of IPSS scores（P=0.075,paired t-test）.Thirty male patients completed the postoperative evaluation of sexual function,and ejaculation was ranked as good in 27（90.0%）,fair in 2（6.7%）,and poor in 1（3.3%）,whereas the potency was good（IIEF,60-75） in 28（93.4%）,fair（IIEF,44-59） in 1（3.3%）,and poor（IIEF,5-43） in 1（3.3%）.There were no significant changes of IIEF scores（P=0.082,paired t-test）.For female patients（n=26）,the postoperative sexual function was ranked as good（FSFI score,76-95） in 23（88.5%）,fair（FSFI,58-75） in 2（7.7%）,and poor（FSFI,4-57） in 1（3.8%）.Furthermore,there were no significant changes of FSFI scores（P=0.122,paired t-test） before and aft

关 键 词：腹腔镜 乙状结肠癌 盆腔自主神经 

分 类 号：R735.35[医药卫生—肿瘤]