摘要
目的分析直肠癌患者腹腔镜直肠癌全系膜切除术后排尿和性功能的状况及其影响因素。方法回顾性研究上海交通大学医学院附属瑞金医院北院普外科2015年1月至2016年12月进行腹腔镜直肠癌全系膜切除术的61例直肠癌患者的临床资料,其中男性41例,女性20例,通过电话和门诊随访评估其术后排尿功能和性功能。观察各临床变量与排尿功能障碍、勃起功能障碍、射精功能障碍的相关性。结果 (1)61例患者中,12例患者发生排尿功能障碍,发生率为19. 7%。其中男性8例(13. 1%),女性4例(6. 5%)。淋巴结转移(P=0. 044)、肿瘤距肛缘的位置(P=0. 005)、手术方式(P <0. 01)与排尿功能障碍的发生有显著相关性。(2)41例男性患者中,13例发生勃起功能障碍,发生率为31. 7%。肿瘤距肛缘的位置(P=0. 045)、手术方式(P=0. 038)、手术野的清晰度(P=0. 018)、直肠前壁的分离平面(P <0. 01)与勃起功能障碍的发生有显著相关性。(3)有性生活的29例男性患者中,10例发生射精功能障碍,发生率为34. 5%。肿瘤距肛缘的位置(P=0. 004)、手术方式(P=0. 03)、直肠前壁的分离平面(P=0. 001)与射精功能障碍的发生有显著相关性。结论肿瘤距肛缘的位置是影响直肠癌术后排尿和性功能障碍发生的主要因素,手术过程中在正确的解剖平面操作避免出血或者通过适当的冲洗止血保持手术野的清洁能够降低术后勃起功能障碍的发生率。在分离直肠前壁时,分离平面避免过度地靠近精囊能有效地减少术后勃起功能和射精功能障碍发生。
Objective To analyze the frenquency and influencing factors of urogenital function after laparoscopic total mesorectal excision. Methods A retrospective study on the clinical data of patients in surgical ward of this hospital during January 2015 to December 2016 were carried out. Sexty-one patients （41 males and 20 females ） had accepted laparoscopic total mesorectal excision. Their postoperative urinary and sexual functions were evaluated by telephone or at outpatient clinic. Tthe correlation among clinical variables and urinary dysfunction, erectile dysfunction and ejaculatory dysfunction were observed and compared. Results ①In 61 patients, 12 patients including 8 males （13.1%） and 4 females （6.5%） had urinary dysfunction. Urinary dysfunction was 19.7%. The metastaasis in lymph nodes （ P =0.014）, the distance from anal margin of tumor （ P =0.05） and the surgical approach （ P 〈0.01） were the influencing factors of urinary dysfunction. ②13 in 41 males patients had erectile dysfunction （31.7%）. The distance from anal margin of tumor （ P =0.045）, the surgical approach （ P =0.038）, the clarity of surgical field （ P =0.018） and the surgical plane between retacl and seminal vesicle （ P 〈0.01） were the influencing factors for erectile dysfunction. ③In 29 males with sexual activities after operation, 10 patients had ejaculation dysfunction （34.5%）. The distance from anal margin of tumor （ P =0.004）, the surgical approach （ P =0.03） and the surgical plane between retacl and seminal vesicle （ P =0.001） were the influencing factors responsible for ejaculation dysfunction. Conclusion The distance from anal margin to tumor is one of the most important influencing factors for urinary and sexual functions. Surgical procedures in a correct anatomical plane to avoid bleeding will reduce the incidence of postoperative erectile dysfunction. The sugical plane to avoid over-close to the seminal vesicle can effectively reduce the postoperative erectile and ejac
作者
施毅卿
刘坤
李军
赵任
SHI Yi-qing; LIU Kun; LI Jun(Department of Surgery, Ruijin Hospital North Afflicated to Shanghai JiaoTong University Medical School, Shanghai 201801, China)
出处
《临床和实验医学杂志》
2018年第21期2314-2317,共4页
Journal of Clinical and Experimental Medicine
基金
上海市卫生和计划生育委员会青年支持项目(编号:20144Y0123)
关键词
直肠癌
腹腔镜手术
全直肠系膜切除术
排尿功能
性功能
Rectal cancer
Laparoscopic surgery
Total mesorectal excision
Urinary function
Sexual function
