直肠癌术后性功能障碍研究进展  

Research progress of sexual dysfunction following rectal cancer surgery

作　　者：赵世栋 祝丽宇 崔艳成[1] 叶颖江[1] 申占龙[1] Zhao Shidong;Zhu Liyu;Cui Yancheng;Ye Yingjiang;Shen Zhanlong(Department of Gastroenterological Surgery,Laboratory of Surgical Oncology,Laboratory of General Surgery,Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research,Peking University People′s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院胃肠外科,北京大学人民医院外科肿瘤研究室,北京市结直肠癌诊疗研究重点实验室,100044

出　　处：《中华胃肠外科杂志》2021年第10期925-930,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金面上项目(81972240)。

摘　　要：性功能障碍是直肠癌术后常见的并发症,发生率为5%~90%,男女比例相似。性功能由腹腔盆腔自主神经支配,直肠癌手术中不同部位、不同程度的盆腔自主神经损伤后性功能障碍的临床表现不尽相同,随着保留盆腔自主神经直肠癌根治术的开展,术后性功能能够得到一定程度的保护。术后心理因素、肠造口、腹会阴联合切除术和放疗可能会增加直肠癌术后性功能障碍发生率。而腹腔镜手术、机器人手术、经肛全直肠系膜切除术及侧方淋巴结清扫对术后性功能的影响尚存争议。基于多学科协作模式,应重视对患者及其伴侣的心理干预,临床上男性应用磷酸二酯酶-5抑制剂、真空负压吸引装置、经阴茎或尿道注射血管扩张剂,女性阴道局部应用雌激素及润滑剂等是直肠癌术后性功能障碍的有效治疗方式。另外,干细胞对治疗性功能损伤具有应用前景。Sexual dysfunction with the incidence of 5%-90%is a common postoperative complication of rectal cancer and the ratio of men and women is similar.Sexual function is innervated by the abdominal-pelvic autonomic nerve.Different sexual dysfunctions can be caused by different parts and degrees of injury in autonomic nerve during operations of rectal cancer.With the development of pelvic autonomic nerves preservation in rectal cancer radical resection,postoperative sexual function can be protected.There may be many factors increasing the incidence of postoperative sexual dysfunction in rectal cancer,such as postoperative psychological factors,stoma,abdominal-perineal resection and radiotherapy.The effects of laparoscopic surgery,robotic surgery,transanal total mesorectal excision and lateral lymph node dissection on postoperative sexual function remain controversial.Based on the multidisciplinary cooperation model,attention should be paid to psychological intervention of patients and their partners.In clinical practice,for male using phosphodiesterase-5 inhibitors,vacuum erectile devices,injection of vasodilators through the penis or urethra,and for female local application of estrogen and lubricants in the vagina are effective treatment for postoperative sexual dysfunction of rectal cancer.In addition,stem cell therapy has a promising prospect for sexual dysfunction.

关 键 词：直肠肿瘤 术后并发症 性功能障碍 

分 类 号：R735.37[医药卫生—肿瘤]