机器人和腹腔镜全直肠系膜切除术保留盆腔自主神经对泌尿和性功能的影响  

Effects of pelvic autonomic nerve preservation in Robotic and laparoscopic total mesorectal excision on urinary and sexual function

作　　者：周玉良 李永翔[1] Zhou Yuliang;Li Yongxiang(NO.1 Affiliated Hospital of Anhui Medical University, Hefei,Anhui 230031, China)

机构地区：[1]安徽医科大学第一附属医院,安徽合肥230031

出　　处：《医药前沿》2019年第19期15-18,共4页Journal of Frontiers of Medicine

摘　　要：目的:分析机器人与腹腔镜全直肠系膜切除术(total mesorectal excision,TME)联合盆腔自主神经保护(pelvic autonomic nerve preservation,PANP)对于直肠癌患者术后排尿及性功能保护作用的差异.方法:选择2016年6月-2017年9月安徽医科大学第一附属医院胃肠外科(腔镜)诊治的98例直肠癌患者,根据其手术方式分为机器人TME+PANP组(RTME+PANP组)和腹腔镜TME+PANP组(LTME+PANP组),采用国际前列腺症状评分表(IPSS)、改良国际勃起功能问卷(IIEF-15)、女性性功能指数(FIFS-19)三个量表,通过问卷调查的方式,对患者术前、术后的排尿功能以及勃起功能、性欲望、性高潮、性欲主观唤醒能力等性功能能力进行评分,从而比较两组患者术后三个量表的得分情况,并进行统计学分析.结果:RTME+PANP组患者术后IPSS得分低于LTME+PANP组患者,且两组数据在术后三个月(10.2±0.6 vs 10.8±1.2)及术后六个月(8.2±0.6 vs 8.6±0.5)差异有统计学意义(P<0.05);RTME+PANP组患者术后IIEF-15得分高于LTME+PANP组患者,且两组数据在术后六个月(46.8±6.2 vs 40.4±8.4)及术后一年(52.2±10.9vs 46.4±8.8)差异有统计学意义(P<0.05);RTME+PANP组患者术后FIFS-19得分高于LTME+PANP组患者,且两组差异有显著统计学意义(P<0.001).比较两组术前IPSS、IIEF-15、FIFS-19得分,差异均无统计学意义(P>0.05).结论:机器人手术能较好的保留患者近期的排尿功能及性功能,且在女性患者性功能保护方面更具优势.Objective To investigate the feasibility and treatment effect of robotic total mesorectal excision (RTME) and pelvic autonomic nerve preservation (PANP) for rectal carcinoma on postoperative urinary and sexual function. Methods During the period of Jue.2016 to Sep.2017, in the department of Laparoscopic Gastrointestinal Surgery of the First Affiliated Hospital of Medical University of Anhui, 98 cases of patients with rectal carcinoma were selected and they were divided into two groups: robotic group (RTME+PANP) and laparoscopic group (UTME+PANP). Questionnaire survey was used to evaluate urinary ability (IPSS), sexual function (IIEF-15 for males, FIFS-19 for females) during preoperative and postoperative time within one year after operation. To compare the scores of the three scales after operation between the two groups, and to carry out statistical analysis. Result Group RTME+PANP patients postoperative IPSS score was lower than that in LTME+PANP group , while in the 3 months (10.2 ± 0.6 vs 10.8 ± 1.2) and 6 months (8.2 ± 0.6 vs 8.6 ± 0.5) after the operation ,the difference was statistically significant (P<0.05). Group RTME+PANP patients postoperative IIEF-15 score was higher than that in ETME+PANP group, The difference was statistically significant in the 6 months (46.8 ± 6.2 vs 40.4 ± 8.4) and 1 year (52.2 ± 10.9 vs 46.4 ± 8.8) after the operation (P<0.05). Group RTME+PANP patients postoperative FIFS-19 score was all higher than that in LTME+PANP group in the 1 year period after the operation, the differences were dramatically significant (PvO.OOl). There was no significant difference among the three score in the two groups (P>0.05). Condusion RTME+PANP reduces patients' suffering in urogenital dysfunction in the short-term, RTME+PANP improve life quality of female patients to the greatest extent .

关 键 词：盆腔自主神经保护 机器人 腹腔镜 全直肠系膜切除 排尿及性功能 

分 类 号：R615[医药卫生—外科学]