以神经为导向的全直肠系膜切除术对直肠癌患者术后性功能的影响  

The effect of nerve-oriented total mesorectal excision on postoperative sexual function in patients with rectal cancer

作　　者：章峥 王一波[1] 叶年源[1] 丁蔚 奚诚 ZHANG Zheng;WANG Yi-bo;YE Nian-yuan(Wujin Hospital Affiliated to Jiangsu University,Changzhou 213000,China)

机构地区：[1]江苏大学附属武进医院,徐州医科大学武进临床学院,213000

出　　处：《中国实用医药》2024年第23期50-53,共4页China Practical Medicine

摘　　要：目的探讨直肠癌患者采用以神经为导向的全直肠系膜切除术(TME)对患者术后性功能的影响。方法选择82例男性直肠癌患者,采用随机数字表法分为观察组、对照组,各41例。观察组采用以神经为导向的TME治疗,对照组采用TME治疗。对比两组国际勃起功能指数问卷表-5(IIEF-5)评分,射精功能及勃起功能分级,排尿功能分级,并发症发生情况及术后复发情况。结果观察组术前及术后3、6个月IIEF-5评分分别为(23.35±1.43)、(20.25±2.39)、(18.42±2.31)分,对照组分别为(23.42±1.62)、(17.50±2.75)、(15.53±2.82)分;术后3、6个月,两组IIEF-5评分均低于本组术前,但观察组IIEF-5评分均高于对照组,差异有统计学意义(P<0.05)。观察组勃起功能Ⅰ、Ⅱ、Ⅲ级分别为35例(85.37%)、5例(12.20%)、1例(2.44%),对照组分别为26例(63.41%)、12例(29.27%)、3例(7.32%);观察组射精功能Ⅰ、Ⅱ、Ⅲ级分别为28例(68.29%)、11例(26.83%)、2例(4.88%),对照组分别为14例(34.15%)、16例(39.02%)、11例(26.83%);观察组勃起功能以及射精功能分级均优于对照组,差异有统计学意义(P<0.05)。观察组排尿功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别为29例(70.73%)、7例(17.07%)、4例(9.76%)、1例(2.44%),对照组分别为16例(39.02%)、15例(36.59%)、7例(17.07%)、3例(7.32%);观察组排尿功能分级优于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率4.88%(2/41)及术后复发率2.44%(1/41)与对照组的9.76%(4/41)、7.32%(3/41)对比,差异无统计学意义(P>0.05)。结论直肠癌患者采用以神经为导向的TME治疗的效果较好,对患者泌尿生殖功能影响较小,且有一定的安全性。Objective To explore the effect of nerve-oriented total mesorectal excision(TME)on postoperative sexual function in patients with rectal cancer.Methods 82 male patients with rectal cancer were selected and divided into an observation group and a control group using a random number table method,with 41 cases in each group.The observation group was treated with nerve-oriented TME,and the control group was treated with TME.The score of International Index of Erectile Function-5(IIEF-5),ejaculatory function and erectile function grading,urination function grading,incidence of complications and postoperative recurrence were compared between the two groups.Results The IIEF-5 scores of the observation group were(23.35±1.43),(20.25±2.39)and(18.42±2.31)points before surgery and 3 and 6 months after surgery,while those of the control group were(23.42±1.62),(17.50±2.75)and(15.53±2.82)points.At 3 and 6 months after surgery,the IIEF-5 scores in both groups were lower than those before surgery,but IIEF-5 score in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).The observation group had 35 cases(85.37%)of erectile function gradeⅠ,5 cases(12.20%)of gradeⅡ,and 1 case(2.44%)of gradeⅢ,while the control group had 26 cases(63.41%)of gradeⅠ,12 cases(29.27%)of gradeⅡ,and 3 cases(7.32%)of gradeⅢ.The observation group had 28 cases(68.29%)of ejaculatory function gradeⅠ,11 cases(26.83%)of gradeⅡ,and 2 cases(4.88%)of gradeⅢ,while the control group had 14 cases(34.15%)of gradeⅠ,16 cases(39.02%)of gradeⅡ,and 11 cases(26.83%)of gradeⅢ.The erectile function grading as well as ejaculatory function grading of the observation group was better than those of the control group,and the difference was statistically significant(P<0.05).The observation group had 29 cases(70.73%)of urination function gradeⅠ,7 cases(17.07%)of gradeⅡ,4 cases(9.76%)of gradeⅢand 1 case(2.44%)of gradeⅣ,while the control group had 16 cases(39.02%)of gradeⅠ,15 cases(3

关 键 词：直肠癌 全直肠系膜切除术 自主神经保留术 性功能 并发症 

分 类 号：R735.37[医药卫生—肿瘤]