CAJ | 학술논문

目的：观察腹腔镜与开腹保留盆腔自主神经直肠癌根治术对老年男性患者排尿功能和性功能的影响。方法：选择2010年1月至2013年6月治疗的直肠癌老年男性患者共90例，依据手术方式分为腹腔镜手术组（51例）和开腹手术组（39例），两组患者均行全直肠系膜切除术及保留盆腔自主神经（TME ＋PANP）。而后对两组患者的术后拔除尿管时间，术后2周和术后3个月的排尿量、最大尿流率、残余尿量以及两组患者术前和术后3个月的勃起和射精功能进行记录并对比分析。结果：术后2周开腹组的排尿障碍发生率是30.7％，腹腔镜组是9.8％，两组差异具有统计学意义（t ＝8.690，P ＝0.015）；两组患者在术后2周的排尿量方面，腹腔镜组（326±33.1）mL、开腹组（323±32.9）mL，差异无统计学意义（t ＝1.310，P ＝0.814），而腹腔镜组尿管拔出时间是（2.6±0.8）d、最大尿流率是（29.8±3.2）mL／s、、残余尿是（15.8±3.6） mL，明显优于开腹组的（5.1±0.9）d、（22.2±3.1）mL／s、（23.1±3.8）mL，两组患者在这3方面的差异具有统计学意义（尿管拔出时间：t ＝8.690，P ＝0.015；最大尿流率：t ＝5.670，P ＝0.042；残余尿：t ＝5.930，P ＝0.038）；在手术3个月后的排尿功能障碍发生率、排尿量、最大尿流率、残余尿量方面腹腔镜组分别为：5.9％、（324±32.6）mL、（29.0±3.2）mL／s、（16.1±3.3）mL；而开腹组分别为：5.1％、（321±32.2）mL、（26.2±3.4）mL／s、（18.5±3.7）mL，两组的差异无统计学意义（排尿障碍率：t ＝2.410，P ＝0.726；排尿量：t＝1.560，P ＝0.792；最大尿流率：t ＝3.310，P ＝0.241；残余尿：t ＝3.720，P ＝0.151）；腹腔镜组患者在术后3个月的勃起功能和射精功能障碍发生率分别为11.7％、13.7％，均低于开腹组的35.9％、38.5％，差异具有统计学意义（勃起障碍率：t ＝8.150，P ＝0.019；射精障碍率：t ＝7.540，P ＝0.023）。结论：直肠癌患者行根治术时保留盆腔自主神经可较好保存患者的排尿功能和性功能，而采用腹腔镜操作创伤小、患者康复快、对神经的损伤较轻微，患者术后排尿和性功能的恢复要优于开腹手术，值得在临床工作中合理应用。目的：觀察腹腔鏡與開腹保留盆腔自主神經直腸癌根治術對老年男性患者排尿功能和性功能的影響。方法：選擇2010年1月至2013年6月治療的直腸癌老年男性患者共90例，依據手術方式分為腹腔鏡手術組（51例）和開腹手術組（39例），兩組患者均行全直腸繫膜切除術及保留盆腔自主神經（TME ＋PANP）。而後對兩組患者的術後拔除尿管時間，術後2週和術後3箇月的排尿量、最大尿流率、殘餘尿量以及兩組患者術前和術後3箇月的勃起和射精功能進行記錄併對比分析。結果：術後2週開腹組的排尿障礙髮生率是30.7％，腹腔鏡組是9.8％，兩組差異具有統計學意義（t ＝8.690，P ＝0.015）；兩組患者在術後2週的排尿量方麵，腹腔鏡組（326±33.1）mL、開腹組（323±32.9）mL，差異無統計學意義（t ＝1.310，P ＝0.814），而腹腔鏡組尿管拔齣時間是（2.6±0.8）d、最大尿流率是（29.8±3.2）mL／s、、殘餘尿是（15.8±3.6） mL，明顯優于開腹組的（5.1±0.9）d、（22.2±3.1）mL／s、（23.1±3.8）mL，兩組患者在這3方麵的差異具有統計學意義（尿管拔齣時間：t ＝8.690，P ＝0.015；最大尿流率：t ＝5.670，P ＝0.042；殘餘尿：t ＝5.930，P ＝0.038）；在手術3箇月後的排尿功能障礙髮生率、排尿量、最大尿流率、殘餘尿量方麵腹腔鏡組分彆為：5.9％、（324±32.6）mL、（29.0±3.2）mL／s、（16.1±3.3）mL；而開腹組分彆為：5.1％、（321±32.2）mL、（26.2±3.4）mL／s、（18.5±3.7）mL，兩組的差異無統計學意義（排尿障礙率：t ＝2.410，P ＝0.726；排尿量：t＝1.560，P ＝0.792；最大尿流率：t ＝3.310，P ＝0.241；殘餘尿：t ＝3.720，P ＝0.151）；腹腔鏡組患者在術後3箇月的勃起功能和射精功能障礙髮生率分彆為11.7％、13.7％，均低于開腹組的35.9％、38.5％，差異具有統計學意義（勃起障礙率：t ＝8.150，P ＝0.019；射精障礙率：t ＝7.540，P ＝0.023）。結論：直腸癌患者行根治術時保留盆腔自主神經可較好保存患者的排尿功能和性功能，而採用腹腔鏡操作創傷小、患者康複快、對神經的損傷較輕微，患者術後排尿和性功能的恢複要優于開腹手術，值得在臨床工作中閤理應用。
목적：관찰복강경여개복보류분강자주신경직장암근치술대노년남성환자배뇨공능화성공능적영향。방법：선택2010년1월지2013년6월치료적직장암노년남성환자공90례，의거수술방식분위복강경수술조（51례）화개복수술조（39례），량조환자균행전직장계막절제술급보류분강자주신경（TME ＋PANP）。이후대량조환자적술후발제뇨관시간，술후2주화술후3개월적배뇨량、최대뇨류솔、잔여뇨량이급량조환자술전화술후3개월적발기화사정공능진행기록병대비분석。결과：술후2주개복조적배뇨장애발생솔시30.7％，복강경조시9.8％，량조차이구유통계학의의（t ＝8.690，P ＝0.015）；량조환자재술후2주적배뇨량방면，복강경조（326±33.1）mL、개복조（323±32.9）mL，차이무통계학의의（t ＝1.310，P ＝0.814），이복강경조뇨관발출시간시（2.6±0.8）d、최대뇨류솔시（29.8±3.2）mL／s、、잔여뇨시（15.8±3.6） mL，명현우우개복조적（5.1±0.9）d、（22.2±3.1）mL／s、（23.1±3.8）mL，량조환자재저3방면적차이구유통계학의의（뇨관발출시간：t ＝8.690，P ＝0.015；최대뇨류솔：t ＝5.670，P ＝0.042；잔여뇨：t ＝5.930，P ＝0.038）；재수술3개월후적배뇨공능장애발생솔、배뇨량、최대뇨류솔、잔여뇨량방면복강경조분별위：5.9％、（324±32.6）mL、（29.0±3.2）mL／s、（16.1±3.3）mL；이개복조분별위：5.1％、（321±32.2）mL、（26.2±3.4）mL／s、（18.5±3.7）mL，량조적차이무통계학의의（배뇨장애솔：t ＝2.410，P ＝0.726；배뇨량：t＝1.560，P ＝0.792；최대뇨류솔：t ＝3.310，P ＝0.241；잔여뇨：t ＝3.720，P ＝0.151）；복강경조환자재술후3개월적발기공능화사정공능장애발생솔분별위11.7％、13.7％，균저우개복조적35.9％、38.5％，차이구유통계학의의（발기장애솔：t ＝8.150，P ＝0.019；사정장애솔：t ＝7.540，P ＝0.023）。결론：직장암환자행근치술시보류분강자주신경가교호보존환자적배뇨공능화성공능，이채용복강경조작창상소、환자강복쾌、대신경적손상교경미，환자술후배뇨화성공능적회복요우우개복수술，치득재림상공작중합리응용。
Objectives:To observe the effect of laparoscopic and open radical pelvic autonomic nerve pres-ervation colorectal cancer surgery on the urinary function and male sexual function of elderly patients.Methods:A total of 90 elderly male patients with colorectal cancer in our hospital from January 2010 to June 2013 were selected, and divided according to the different surgeries,39 cases using open surgery and 51 cases using laparoscopic surger-y.Patients in both groups received Mesangial full rectal excision surgery and pelvic autonomic nerve preservation (TME +PANP).The postoperative catheter removal time,urine output of after 2 weeks and after three months, maximum flow rate,residual urine volume,and the erection and ejaculation function of two groups of patients,be-fore and 3 months after operation were recorded and comparatively analyzed.Results:For patients in the open sur-gery group,the incidence of voiding dysfunction two weeks after was higher than that in the laparoscopic surgery group,with statistically significant difference (open surgery group of 30.7%,laparoscopic surgery group of 9.8%;t =8.69,P =0.015).The differences between the two groups in terms of urine output after two weeks was of no statistical significance (open surgery group of 326 ±33.1mL,laparoscopic surgery group of 323 ±32.9mL;t =1.31,P =0.814).The catheter pull out of time,maximum flow rate,residual urine of the laparoscopic group were 2.6 ±0.8d,29.8 ±3.2mL/s,and 15.8 ±3.6mL respectively,better than the open surgery group,which were 5.1 ±0.9d,22.2 ±3.1mL/s and 23.1 ±3.8mL.The difference was statistically significant (catheter pull out of time:t =8.69,P =0.015;maximum flow rate:t =5.67,P =0.042;residual urine:t =5.93,P =0.038).3 months after surgery,the incidence of voiding dysfunction,urine output,maximum flow rate and residual urine of the lapa-roscopic group were 5.9%,324 ±32.6mL,29.0 ±3.2mL/s and 16.1 ±3.3mL,better than the open surgery group of 5.1%,321 ±32.2mL,26.2 ±3.4mL/s and 18.5 ±3.7mL,without statistically significant difference(u-rination disorders:t =2.41,P =0.726;urine output:t =1.56,P =0.792;maximum flow rate:t =3.31,P =0.241;residual urine:t =3.72,P =0.151).3 months after surgery,the incidence of erectile dysfunction and e-jaculatory dysfunction in the laparoscopic group were 11.7% and 13.7%,lower than the laparotomy group (35.9%,38.5%).The difference was statistically significant (erectile dysfunction rate:t =8.15,P =0.019;e-jaculatory dysfunction rate:t =7.54,P =0.023).Conclusion:Pelvic autonomic nerve preservation radical surgery may be better to save the urinary function and sexual function of colorectal cancer patients.With less invasive, quick recovery and relatively minor nerve damage,laparoscopic operation is worthy of clinical application,besides its superior postoperative recovery urination and sexual function to open surgery.