手助腹腔镜全直肠系膜切除术中盆自主神经保护对男性性功能的影响(1)
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[摘要] 目的 探讨手助腹腔镜全直肠系膜切除术中盆腔自主神经保护的可行性及对术后性功能的影响。方法 2011年1～7月应用手助腹腔镜完成男性直肠癌全直肠系膜切除术19例，以同期开腹手术22例作对照。比较术后性功能障碍的发生率。结果 手助腹腔镜组与开腹组术后勃起功能障碍发生率分别为10.53%、13.64%，射精功能障碍发生率分别为21.05%、22.73%；两组比较差异无统计学意义(P > 0.05)。结论 手助腹腔镜全直肠系膜切除术中盆腔自主神经保护安全、可行，术中能更清晰地显露盆腔自主神经并予以保护,有效地降低术后性功能障碍的发生率。
[关键词] 全直肠系膜切除术；手辅助腹腔镜；盆腔自主神经保护；性功能
[中图分类号] R735.3+7 [文献标识码] B [文章编号] 1673-9701(2012)04-0074-02
Effect of pelvic autonomic nerve preservation on sexual function in male patients with rectal carcinoma undergoing hand-assisted laparoscopic total mesorectal excision
SONG Yucheng ZHANG Xuedong YUAN Yuan SONG Xiaofei ZHANG Guangtan ZHANG Peng
Department of General Surgery，Henan Provincial People’s Hospital，Zhengzhou 450003，China
[Abstract] Objective To evaluate the sexual function of male patients with rectal carcinoma following hand-assisted laparoscopic total mesorectal excision with pelvic autonomic nerve preservation. Methods From January to July 2011, 19 male patients were allocated to hand-assisted laparoscopic total mesorectal excision and 22 to open TME.The clinical data of patients were retrospectively analyzed.The sexual dysfunction rate of male patients in the two groups were compared. Results The erectile dysfunction and ejaculatory disorder rate were 10.53% and 21.05% in the hand-assisted laparoscopic group, and13.64%、22.72% in the open groug, respectively. No significant difference between the two groups was found (P > 0.05). Conclusion Pelvic autonomic nerve preservation through hand-assisted laparoscopic total mesorectal excision is safety and feasible, and can effectively reduce the incidence of sexual dysfunction after operation. It is more easier for exposure and protection pelvic autonomic nerve in the operation.
[Key words] Total mesorectal excision; Hand-assisted laparoscopy; Pelvic autonomic nerve preservation; Sexual function
目前，全直肠系膜切除术(total mesorectal excision， TME)仍是中下段直肠癌手术的标准术式。高质量的TME要求术中锐性分离、环周切缘阴性、盆自主神经保护，这样才能保证肿瘤根治性和最大限度减少术后排尿和性功能障碍。手助腹腔镜手术是在腹腔镜手术基础上，通过特定手助器，术者将手伸入腹腔从而协助完成手术[1]。具有安全、微创并缩短腹腔镜手术学习曲线等优点，是全腔镜手术的有力补充。我科应用手助腹腔镜手术治疗中下段直肠癌 ......
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