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目的探讨腹腔镜下行中低位直肠癌根治术保留盆腔自主神经(PANP)对中青年男性性功能和排尿功能的影响。方法选取中低位直肠癌男性患者86例,Dukes A、B、C1期。根据手术方式,将患者分为直肠癌全系膜切除术(TME)+PANP组(观察组)和TME组(对照组),每组43例。比较两组术后性功能(勃起功能和射精功能)、排尿功能障碍及局部复发率。结果两组均顺利完成手术,观察组有3例患者因有肿大淋巴结转移征象改行扩大根治术放弃PANP(列入对照组)。术后随访2~5年。观察组术后勃起、射精、排尿功能障碍发生率分别为20.0%、27.5%、12.5%,对照组勃起、射精、排尿功能障碍发生率分别为41.3%、50.0%、30.4%,差异有统计学意义(P<0.05)。两组局部复发率差异无统计学意义(P>0.05)。结论腹腔镜下治疗中青年男性中低位直肠癌可在根治的基础上实施PANP手术,降低对患者性功能和排尿功能的影响。
Objective To investigate the effect of laparoscopic radical rectal cancer preserving pelvic autonomic nerve (PANP) on sexual function and urinary function in young and middle-aged men. Methods 86 cases of low and middle rectal cancer male patients, Dukes A, B, C1 period. According to the surgical method, the patients were divided into TME + PANP group (observation group) and TME group (control group), 43 cases in each group. The postoperative sexual function (erectile function and ejaculation function), urinary dysfunction and local recurrence rate were compared between the two groups. Results The two groups were successfully completed the operation, the observation group of 3 patients with enlarged lymph node metastasis due to diverting radical surgery to give up PANP (included in the control group). Follow-up 2 to 5 years after operation. The incidences of postoperative erectile, ejaculation and voiding dysfunction in the observation group were 20.0%, 27.5% and 12.5%, respectively. The incidence of erectile dysfunction, ejaculation and urination dysfunction in the observation group were 41.3%, 50.0% and 30.4% respectively, with statistical difference Significance (P <0.05). There was no significant difference in the local recurrence rate between the two groups (P> 0.05). Conclusion Laparoscopic treatment of middle-aged and young men with low rectal cancer can be implemented on the basis of radical PANP surgery to reduce the impact of sexual function and urinary function.