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目的:比较保留盆腔自主神经的低位直肠癌根治术(PANP+TME)的腹腔镜术式与开放手术对男性性功能与排尿功能的影响。方法:术前无性功能与排尿功能障碍的81例B期或C1期60岁以下的男性低位直肠癌患者纳入研究范围,其中43例为行保留自主神经的腹腔镜直肠癌全系膜根治术组(腹腔镜组),38例为行保留自主神经的开放手术组(开腹组),比较腹腔镜组与开腹组患者的术后排尿障碍和6个月后的性功能障碍的发生率。结果:腹腔镜组切除的淋巴结总数、安全距远切缘分别是(16.5±3.9)个和3.1 cm(1.5~5.5 cm),开腹组切除的淋巴结总数、安全距远切缘分别是(16.2±4.2)个和3.3 cm(1.6~5.7 cm)。腹腔镜组术后勃起功能障碍、射精功能障碍和术后排尿功能障碍的发生率分别为27.91%(12/43),25.58%(11/43),16.28%(7/43);开腹组分别为28.95%(11/38),23.68%(9/38)、13.16%(5/38);两组比较均无统计学意义(P>0.05)。结论:腹腔镜直肠癌根治术能有效切除低位的Dukes B期和C1期直肠癌患者的肿瘤组织,具有与开放手术相仿的保留盆腔自主神经的效果。
OBJECTIVE: To compare the effects of laparoscopic surgery and open surgery on male sexual function and voiding function in patients with pelvic autonomic nerve radical rectal cancer (PANP + TME). METHODS: Totally 81 male patients with stage B or C1 lower than 60 years of age with preoperative asexual dysfunction and micturition dysfunction were enrolled in the study. Among them, 43 patients underwent laparoscopic radical mastectomy with laparoscopic rectal cancer (Laparoscopic group). 38 patients underwent open surgery (open group) with autonomic nerve preservation. The incidence of postoperative urination disorder and the incidence of sexual dysfunction after 6 months were compared between laparoscopic group and open group. Results: The total number of lymph nodes excised from the laparoscopic group was (16.5 ± 3.9) mm and 3.1 cm (1.5-5.5 cm) respectively. The total number of excised lymph nodes in the open group was (16.2 ± 4.2) and 3.3 cm (1.6 ~ 5.7 cm). The incidences of postoperative erectile dysfunction, ejaculation dysfunction and postoperative urination dysfunction were 27.91% (12/43), 25.58% (11/43) and 16.28% (7/43) respectively in laparoscopic group. In open group 28.95% (11/38), 23.68% (9/38) and 13.16% (5/38) respectively. There was no significant difference between the two groups (P> 0.05). Conclusions: Laparoscopic radical resection of rectal cancer can effectively excise the tumor tissue of patients with low-grade Dukes B and C1 rectal cancer, and has the same effect of preserving pelvic autonomic nerve as open surgery.