Maas C P, Moriya Y, Steup W H, Klein Kranenbarg E, van de Velde C J
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Eur J Surg Oncol. 2000 Dec;26(8):751-7. doi: 10.1053/ejso.2000.0998.
Preservation of the pelvic autonomic nerves is thought to lower bladder and sexual dysfunction after rectal cancer surgery. A prospective study was undertaken in a Dutch population to evaluate functional outcome, local recurrence and survival of a Japanese operative technique combining nerve preservation with radical tumour resection.
Forty-seven patients were operated upon by a Japanese surgeon. Voiding and sexual function were prospectively analysed using questionnaires. Two-year follow-up on urinary function was complete in 73%, and 2-year follow-up of male sexual function was complete in 77%. Median follow-up for survival and recurrence was 42 months and was complete in all patients.
Five patients (19%) developed minor urinary incontinence in the period between 1 and 2 years of follow-up. Six patients (22%) had a persistently elevated frequency of voiding. There was no statistically significant correlation between the extent of nerve preservation and the reported minor voiding dysfunctions. None of the patients reported major incontinence of urine. Impotence was related to sacrifice of the inferior hypogastric plexus and ejaculatory dysfunction was related to sacrifice of the superior hypogastric plexus. Sexual function did not change during follow-up. Of 42 curatively-operated patients, three (7.1%) developed local recurrence. Sixty-seven per cent were overall free of recurrence. Disease-free survival was 57%.
Preservation of the pelvic autonomic nerves minimizes bladder dysfunction after rectal cancer surgery. The preservation of the total autonomic nerve system is essential for normal sexual function in male patients. Nerve preservation does not compromise radicality in mesorectal excision. Mesorectal excision should involve identification and preservation of the pelvic autonomic nerves.
保留盆腔自主神经被认为可降低直肠癌手术后膀胱和性功能障碍的发生率。在荷兰人群中进行了一项前瞻性研究，以评估一种将神经保留与根治性肿瘤切除相结合的日本手术技术的功能结局、局部复发情况和生存率。
由一位日本外科医生为47例患者实施手术。使用问卷对排尿和性功能进行前瞻性分析。73%的患者完成了2年的尿功能随访，77%的男性患者完成了2年的性功能随访。所有患者的生存和复发情况的中位随访时间为42个月，且全部完成。
5例患者（19%）在随访1至2年期间出现轻度尿失禁。6例患者（22%）排尿频率持续升高。神经保留程度与所报告的轻度排尿功能障碍之间无统计学显著相关性。没有患者报告严重尿失禁。阳痿与下腹下丛的损伤有关，射精功能障碍与上腹下丛的损伤有关。随访期间性功能未发生变化。在42例接受根治性手术的患者中，3例（7.1%）出现局部复发。67%的患者总体无复发。无病生存率为57%。
保留盆腔自主神经可将直肠癌手术后的膀胱功能障碍降至最低。保留整个自主神经系统对男性患者的正常性功能至关重要。神经保留并不影响直肠系膜切除的根治性。直肠系膜切除应包括识别和保留盆腔自主神经。
