腹腔镜直肠癌根治术中保留与切除Denonvilliers筋膜对男性排尿及性功能影响的Meta分析  

Meta-analysis of the effect of Denonvilliers’fascia preservation versus resection during laparoscopic total mesorectal excision on male urination and sexual function

作　　者：熊海波 邓立豪 邓力宾 曾云龙[1] 李叔强[1] 强正宏[1] 袁家天[1] 吕波[1] 李俊[1] Xiong Haibo;Deng Lihao;Deng Libin;Zeng Yunlong;Li Shuqiang;Qiang Zhenghong;Yuan Jiatian;Lv Bo;Li Jun(Department of Gastroenterology,Affiliated Hospital of Chengdu University,Chengdu Sichuan 610061,China)

机构地区：[1]成都大学附属医院胃肠外科,成都610081

出　　处：《中华普外科手术学杂志（电子版）》2023年第5期497-501,共5页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：成都大学临床医学院、附属医院2022年院级科研课题项目(Y202236)。

摘　　要：目的:通过meta分析来评价男性直肠癌患者在腹腔镜下行根治手术中保留和切除denonvilliers筋膜(DVF)对排尿和性功能的影响。方法:通过检索Pubmed、FMRS图书馆、万方、维普、中国知网等大型文献数据库,文献检索起止日期从建库到2022年8月。应用Revman 5.3软件进行Meta分析,运用STATA14.0进行Begg's测试对各研究间发表偏倚进行评估。结果:共纳入9篇文献915例患者,实验组保留DVF(n=457例),对照组不保留DVF(n=458例)。实验组的排尿功能障碍、性功能障碍、射精功能障碍发生率明显低于对照组,差异有统计学意义(Z=5.92,2.82,5.69;P<0.05),实验组有更高的最大尿流量和国际勃起功能问卷表评分,差异均有统计学意义(Z=12.32,5.34;P<0.05)。逐个剔除纳入相关文献后再进行敏感分析,最终统计的结果对比无明显改变,Begg's检验提示射精功能障碍的漏斗图呈现表明无发表偏倚(P=0.315)。结论:腹腔镜直肠癌根治术中保留DVF可有效保护男性患者盆腔自主神经功能,从而更有效地避免患者术后排尿功能和性功能障碍的发生。Objective A meta-analysis was performed to evaluate the effects of preserving and removing denonvilliers fascia(DVF)during laparoscopic radical surgery on urination and sexual function in male patients with rectal cancer.Methods By searching large literature databases such as Pubmed,FMRS Library,Wanfang,Weipu,CNKI,etc.,the literature search started and ended from the establishment of the database to August 2022.Meta-analysis was performed using Revman 5.3 software,and Begg's test was performed using STATA14.0 to evaluate publication bias among studies.Results A total of 915 patients in 9 literatures were included.The experimental group retained DVF(n=457 cases)and the control group did not retain DVF(n=458 cases).The incidence of urinary dysfunction,sexual dysfunction and ejaculatory dysfunction in the experimental group was significantly lower than that in the control group,and the difference was statistically significant(Z=5.92,2.82,5.69;P<0.05),the experimental group had higher maximum urinary flow and international erectile function questionnaire scores,and the differences were statistically significant(Z=12.32,5.34;P<0.05).Sensitivity analysis was carried out after the relevant literatures were excluded one by one,and there was no significant change in the comparison of the final statistical results.The funnel plot of Begg's test indicating ejaculatory dysfunction showed no publication bias(P=0.315).Conclusion Retention of DVF during laparoscopic radical resection of rectal cancer can effectively protect the function of pelvic autonomic nerve in male patients,so as to more effectively avoid the occurrence of postoperative urination function and sexual dysfunction.

关 键 词：直肠肿瘤 筋膜 Denonvilliers 腹腔镜 排尿功能 性功能 

分 类 号：R735.37[医药卫生—肿瘤]