腹腔镜下PANP+TME与TME对男性直肠癌术后排尿、性功能的保护效果研究  

The protective effect of PANP+TME and TME on urination and sexual function after operation of male rectal cancer under laparoscopy

作　　者：王雄飞 邵建平[1] 赵磊[1] 刘春庆[1] 刘正[2] Wang Xiongfei;Shao Jianping;Zhao Lei;Liu Chunqing;Liu Zheng(General surgery,People's Hospital Daxing District,Beijing 102600,China;Department of Colorectal Surgery,Cancer Hospital,Chinese Academy cf Medical Sciences,Beijing 100021,China)

机构地区：[1]北京市大兴区人民医院普外科,北京102600 [2]中国医学科学院肿瘤医院结直肠外科,北京100021

出　　处：《中华普外科手术学杂志（电子版）》2022年第1期22-26,共5页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：北京市科学技术委员会重点项目(Z161100000116090)。

摘　　要：目的探讨腹腔镜下保留盆腔自主神经(PAN)的全直肠系膜切除术(TME)对男性直肠癌术后排尿、性功能的保护效果。方法前瞻性纳入2018年1月至2019年12月行腹腔镜TME的男性直肠癌患者98例,随机数字法分为:对照组和PANP组各49例。对照组不保留PAN,PANP组保留PAN。采用软件SPSS 22.0处理数据,围手术期指标等计量资料以(x±s)表示,行独立样本/检验;排尿、勃起、射精功能障碍情况等计数资料行χ^(2)检验,排尿、勃起、射精功能分级等等级计数资料行秩和检验;生存分析采用Kaplan-Meier法并行Log-rank检验。P<0.05表示差异有统计学意义。结果与对照组比,PANP组患者术后肠鸣音恢复时间、排气时间及住院时间均显著缩短,淋巴结清扫枚数显著增加(P<0.05);而手术时间及术中出血量比较,差异无统计学意义(P〉0.05);PANP组患者术后排尿、勃起及射精功能均显著优于对照组(P<0.05),且术后排尿、勃起及射精功能障碍发生率较对照组均明显降低,差异均有统计学意义(P<0.05);对照组与PANP组患者的累积无病生存率(85.7% vs 93.9%)比较,差异无统计学意义(P=0.204)。结论腹腔镜下PANP+TME不仅能使患者早日康复,而且对患者术后排尿、性功能也具有更好的保护效果,值得临床推广应用。Objective To investigate the protective effect of laparoscopic total mesenterectomy(TME)with pelvic autonomic nerve(PAN)preservation on urination and sexual function in male rectal cancer surgery.Methods 98 male rectal cancer patients who underwent laparoscopic TME from January 2018 to December 2019 were prospectively enrolled and divided into control group(n=49)and PANP group(n=49).PAN was not preserved in the control group and was preserved in PANP group.SPSS 22.0 software was used or data processing.Perioperative indexes and other measurement data were expressed by(x±s),The statistical data of voiding,erectile and ejaculation dysfunction were χ^(2) test,and the statistical data of voiding,erectile and ejaculation function were rank-sum test.Kaplan-meier method and log-rank test were used for survival analysis.P<0.05 indicated a statistically significant difference.Results Compared with the control group,postoperative bowel sound recovery time,exhaust time and hospital stay were significantly shortened in PANP group,and the number of lymph node dissection was significantly increased(P<0.05).There was no statistical difference in the operation time and intraoperative blood loss(P>0.05);The function of urine,erection and ejaculation of PANP group was significantly better than that of control group,the differences were statistically significant(P<0.05).There was no significant difference in the cumulative disease-free survival rate between PANP group and control group(85.7%vs.93.9%,P=0.204).Conclusion Laparoscopic PANP+TME can not only promote the early recovery of patients,but also has better protective effect on postoperative urination and sexual function,which is worthy of clinical application.

关 键 词：腹腔镜 盆腔自主神经 全直肠系膜切除术 排尿功能 性功能 

分 类 号：R735.37[医药卫生—肿瘤]