3D腹腔镜与开腹直肠癌根治术对男性性功能及泌尿功能的影响  

Effect of open versus 3D laparoscopic surgery for rectal cancer on male urinary and sexual function

作　　者：高庆坤[1] 牛鹏飞[1] 王延召[1] 高兆亚 黄文生[1] 雷福明[1] 顾晋[1] Gao Qingkun;Niu Pengfei;Wang Yanzhao;Gao Zhaoya;Huang Wensheng;Lei Fuming;Gu Jin(Department of Gastrointestinal Surgery,Peking University Shougang Hospital,Beijing 100043,China)

机构地区：[1]北京大学首钢医院胃肠外科

出　　处：《中华临床医师杂志（电子版）》2019年第4期246-253,共8页Chinese Journal of Clinicians(Electronic Edition)

基　　金：北京市科委，首都临床特色应用研究(Z161100000516003)

摘　　要：目的对比分析3D腹腔镜与开腹直肠癌根治术围手术期相关因素对性功能和泌尿功能的影响。方法回顾性分析2015年1月至2016年10月北京大学首钢医院37例男性直肠癌患者临床资料,患者的性功能及泌尿功能分别通过性功能评分(IIEF)和泌尿功能评分(IPSS)问卷调查表的形式获得,所有患者随访时间点为术后3个月、6个月和12个月。采用t检验比较传统开腹手术组和3D腹腔镜手术组患者的年龄、体质量指数(BMI)、手术时间及失血量的差异,采用χ^2检验比较2组患者肿瘤TNM分期、肿瘤位置、淋巴结转移与否、T分期、术式、并发症及化疗等指标的差异。各观察指标对IIEF和IPSS评分的影响分析采用秩和检验比较各组内的差异;术后12个月的IIEF和IPSS评分的影响因素采用多元线性回归分析。结果15例患者接受3D腹腔镜手术,22例患者接受开腹手术。2组患者年龄、BMI、TNM分期、肿瘤位置、淋巴结、T分期、术式、并发症及化疗方面比较,差异无统计学意义(P均>0.05)。3D腹腔镜直肠癌手术组患者手术时间明显长于传统开腹手术组[(222.67±41.40)min vs (159.36±21.26)min],差异具有统计学意义(F=6.414,P<0.05),但3D腹腔镜手术组手术出血量明显少于传统开腹组[(375.45±252.20)ml vs (161.33±165.57)ml],差异具有统计学意义(F=2.654,P<0.05)。低位肿瘤患者在术后3、6、12个月的IIEF评分较高位肿瘤患者减低,差异具有统计学意义(Z=-3.698、-3.445、-3.668,P均<0.05)。术中出血大于500 ml患者的IIEF评分在术后3、6、12个月均明显减低,差异具有统计学意义(Z=-2.785、-2.644、-2.538,P均<0.05);在术后3、6、12个月,高龄组的IPSS评分均高于低龄组,差异具有统计学意义(H=15.810、17.926、18.162,P均<0.05)。术后3个月低位肿瘤患者的IPSS评分明显高于高位肿瘤患者,差异具有统计学意义(Z=-0.268,P=0.045)。多元线性回归分析结果显示,患者年龄、肿瘤位�Objective To prospectively assess the sexual and urinary functions as well as factors influencing these functions in patients undergoing open or 3D laparoscopic surgery for rectal cancer. Methods A retrospective analysis was performed of the clinical data of 37 male rectal cancer patients treated at Shougang Hospital, Peking University from January 2015 to October 2016. Their sexual and urinary functions were assessed through self-administered questionnaires comprising the International Index of Erectile Function (IIEF;sexual function) and the International Prostate Symptom Score (IPSS;urinary function) before and 3, 6, and 12 months after surgery. Age, body mass index (BMI), operation time, and blood loss were compared between the two groups by the t-test. Tumor TNM stage, tumor location, N stage, T stage, surgical procedure, complications, and chemotherapy were compared by the chi-square test. The influence of each of these observation factors on IIEF and IPSS scores was analyzed by the rank sum test. The influencing factors on IIEF and IPSS scores at 12 months after operation were analyzed by multiple linear regression. Results Fifteen patients who underwent 3D laparoscopic surgery and 22 patients who underwent open surgery were finally analyzed in this study. There were no significant differences in age, BMI, TNM stage, N stage, T stage, surgical procedure, complications, or chemotherapy between the two groups (P>0.05). The operation time of the 3D laparoscopic operation group was significantly longer than that of the traditional open surgery group [(222.67±41.40) min vs (159.36±21.26) min, F=6.414, P<0.05]. The amount of bleeding in the 3D laparoscopic rectal cancer operation group was significantly lower than that in the traditional open surgery group [(375.45±252.20) ml vs (161.33±165.57) ml, F=2.654, P<0.05]. The IIEF scores of patients with low tumor location were significantly lower than those of patients with high tumor location at 3, 6, and 12 months after operation (Z=-3.698,-3.445,-3.668, P<0.05

关 键 词：3D腹腔镜手术 直肠癌 性功能 泌尿功能 

分 类 号：R735.37[医药卫生—肿瘤]