保留盆腔自主神经的腹腔镜经肛拖出直肠癌根治术(1)
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[摘要] 目的：分析男性患者采用保留盆腔自主神经的腹腔镜经肛拖出直肠癌根治术后患者的预后和性功能变化情况，评价该手术安全性和可行性。方法：选择本院就诊的中低位直肠癌患者分为腹腔镜组和开腹组，分别进行保留盆腔自主神经的腹腔镜经肛拖出直肠癌根治术和开腹直肠癌根治术。以问卷形式调查患者的排尿及性功能情况。结果：开腹组术后性能力障碍者9例(30.0%)，腹腔镜组术后性能力障碍者3例(8.3%)，差异有统计学意义(P<0.05)。EF 领域得分在术后3个月开腹组为13.3±6.6，腹腔镜组为18.2±6.6，有明显差异，术后6个月，开腹组为15.5±5.5，腹腔镜组为20.3±5.3，差异有统计学意义。术后膀胱排尿功能，局部复发率两组无明显差异(P>0.05)。结论：腹腔镜经肛拖出直肠癌根治术较开腹直肠癌根治术能更好地保护盆腔自主神经，保留患者的性功能，具有可靠的安全性和可行性, 并由于其更微创，易于被患者接受，值得在临床应用。
[关键词] 腹腔镜；直肠癌；全系膜直肠切除术；神经保护
[中图分类号] R735.3+7[文献标识码] C [文章编号] 1674-4721(2011)06(b)-018-03
Laparoscopic transanal pull-through with nerve sparing radical resection of rectal carcinoma
YUAN Long, LI Zhi, XU Benling, WU Huize, HAN Guangsen
Department of General Surgery, Zhengzhou University Affiliated Tumor Hospital (Henan Tumor Hospital), Henan Province, Zhengzhou 450008, China
[Abstract] Objective: To explore the efficacy, feasibility, safety of laparoscopic transanal pull-through (LTPT) with nerve sparing radical resection of rectal carcinoma. Methods: Bladder and male sexual function were studied by means of a questionnaire on the basis of the international prostatic symptom score (IPSS) and international index of erectile function (IIEF). In addition, bladder function was determined by means of postvoid residual urine measurement. Outcomes were compared between patients who underwent open (n=30) and laparoscopic (n=36) transanal pull-through with nerve sparing radical resection of rectal carcinoma. Results: Impotency after surgery was experienced by 9 of 30 preoperatively sexually active males (30.0%) in open group and 3 of 36 males (8.3%) in laparoscopic group (P=0.04). It had significant difference in EF domain score between open group and laparoscopic group after surgery 3 months and 6 months (P<0.05). It had no significant difference in bladder urinary function, local recurrence between open group and laparoscopic group. Conclusion: Laparoscopic pull-through transanal rectal cancer surgery with nerve sparing offers a significant advantage with regard to preservation of postoperative sexual function ......
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