直肠癌Miles术保留盆腔自主神经的评价  

The Assessment of Pelvic Autonomic Nerve Preservation in Miles Operation for Rectal Cancer

作　　者：何炜杰[1] 胡浩[2] 汪良[2] 钱海鑫[2] 

机构地区：[1]苏州大学医院外科,苏州215006 [2]苏州大学附属第一医院普外科,苏州215006

出　　处：《苏州医学院学报》2001年第6期672-674,共3页Acta Academiae Medicinae Suzhou

摘　　要：目的　评价直肠癌Miles术保留盆腔自主神经的临床效果。方法　 15 9例男性直肠癌患者行Miles术结合盆腔自主神经全保留、单侧保留、部分保留 ,评价术后的肿瘤结果、性功能及排尿功能。结果　总的局部复发率为 18.2 % ,5年生存率为 6 3.5 %。术后性功能 :保持勃起、性交者 79.2 % ;能射精者 30 .8% ,其中全保留组为6 5 .1% ,单侧保留组为 13.8% ;阳萎患者为 2 0 .8%。术后排尿功能 :拔除导尿管时能自行排尿且残余尿 <5 0ml者10 5例 ,占 6 6 .0 % ,平均拔管时间为 3.2d ;残余尿量在 5 0～ 10 0ml者 41例 ,占 2 5 .8% ,平均拔管时间为 6 .8d ;残余尿量 >10 0ml者 13例 ,占 8.2 % ,其中 5例出院时仍需留置导尿管。结论　保留盆腔自主神经的Miles术不增加局部复发率 ,不减低 5年生存率 ,却能改善患者的性功能及排尿功能。Objective To evaluate the clinical effect of pelvic autonomic nerve preservation in Miles operation for rectal cancer.Methods The oncologic and functional outcomes were analyzed in 159 male patients undergoing Miles operation for rectal cancer plus the complete, unilateral, partial pelvic autonomic never preservation.Results The total local recurrence rate was 18.2%. The 5-year survival rate was 63.5%. Of these patients, 79.2% was maintained the ability to engage in se xual intercourse. And 30.8% was capable of achieving ejaculation,among which 65.1% and 13.8% were in complete and unilateral preservation.Impotence was developed in 20.8% of the patients. Spontaneous voiding when the urethral catheter was removed 3.2 days after operation took account for 66.0%,6.8 days for 25.8% patients suffering from temporary urinary dysfunction and 8.2% of those patients led to the long-term urinary dysfunction.Conclusion These data show that the outcome of urinary and sexual function is better after pelvic autonomic nerve preservation in Miles operation for rectal cancer. It is a worthy procedure for the balance between achieving a cure and preserving autonomic function.

关 键 词：直肠肿瘤 MILES术 盆腔自主神经保留 性功能 排尿功能 

分 类 号：R735.37[医药卫生—肿瘤] R730.56[医药卫生—临床医学]