Kim Nam Kyu, Aahn Tae Wan, Park Jea Kun, Lee Kang Young, Lee Woong Hee, Sohn Seung Kook, Min Jin Sik
Department of Surgery, Yonsei University, College of Medicine, Seoul, Korea.
Dis Colon Rectum. 2002 Sep;45(9):1178-85. doi: 10.1007/s10350-004-6388-5.
Total mesorectal excision with pelvic autonomic nerve preservation has been reported to be an optimal surgery for rectal cancer. It minimizes local recurrence and sexual and urinary dysfunction. The aim of this study was to assess the safety of total mesorectal excision with pelvic autonomic nerve preservation in terms of voiding and sexual function in males with rectal cancer.
We performed urine flowmetry using Urodyn and a standard questionnaire using the International Index of Erectile Function and the International Prostate Symptom Score before and after surgery in 68 males with rectal cancer.
Significant differences in mean maximal urinary flow rate and voided volume were seen before and after surgery (18.9 +/- 5.7 13.7 +/- 7.0, 240 +/- 91.9 143 +/- 78; < 0.05, < 0.05, respectively), but no differences in residual volume before and after surgery were apparent (4.4 +/- 2.6 8.1 +/- 4.4; > 0.05). The total International Prostate Symptom Score was increased after surgery from 6.2 +/- 5.8 to 9.8 +/- 5.9 ( < 0.05). There were no changes of score for one of each of seven International Prostate Symptom Score items in 49 patients (73.5 percent) to 61 patients (89.7 percent). Five International Index of Erectile Function domain scores (erectile function, intercourse satisfaction, orgasmic function, sexual desire, and overall satisfaction) were significantly decreased after surgery (18.2 +/- 9.3 13.5 +/- 9, 8.4 +/- 4.2 4.4 +/- 2.9, 5.8 +/- 2.9 4.4 +/- 2.9, 6.1 +/- 2.4 4.8 +/- 2, 6.1 +/- 2.2 4.5 +/- 2.3, respectively; < 0.05). Erection was possible in 55 patients (80.9 percent); penetration ability was possible in 51 patients (75 percent). Complete inability for erection and intercourse was observed in three patients (5.5 percent). Retrograde ejaculation was noted in 9 patients (13.2 percent). International Index of Erectile Function domains such as sexual desire and overall satisfaction were greatly decreased in 39 patients (57.4 percent) and 43 patients (63.2 percent), respectively. Multiple regression analysis of factors affecting postoperative sexual dysfunction showed that age older than 60 years (sexual desire, P = 0.019), within six months (erectile function, P = 0.04; intercourse satisfaction, P = 0.011; orgasmic function, P = 0.03), lower rectal cancer (erectile function, P = 0.02; intercourse satisfaction, P = 0.036; orgasmic function, P = 0.027) were significant factors adversely affecting sexual function.
Total mesorectal excision with pelvic autonomic nerve preservation showed relative safety in preserving sexual and voiding function. The International Prostate Symptom Score and International Index of Erectile Function questionnaires were useful in assessing urinary and sexual function.
据报道，保留盆腔自主神经的全直肠系膜切除术是直肠癌的最佳手术方式。它能将局部复发以及性功能和排尿功能障碍降至最低。本研究的目的是评估保留盆腔自主神经的全直肠系膜切除术对男性直肠癌患者排尿和性功能方面的安全性。
我们对68例男性直肠癌患者在手术前后使用尿动力学仪进行尿流率测定，并使用国际勃起功能指数和国际前列腺症状评分标准问卷。
手术前后平均最大尿流率和排尿量存在显著差异（分别为18.9±5.7对13.7±7.0，240±91.9对143±78；P<0.05，P<0.05），但手术前后残余尿量无明显差异（4.4±2.6对8.1±4.4；P>0.05）。国际前列腺症状评分总分术后从6.2±5.8增加到9.8±5.9（P<0.05）。49例患者（73.5%）至61例患者（89.7%）的七个国际前列腺症状评分项目中的一项得分无变化。术后国际勃起功能指数的五个领域评分（勃起功能、性交满意度、性高潮功能、性欲和总体满意度）显著降低（分别为18.2±9.3对13.5±9，8.4±4.2对4.4±2.9，5.8±2.9对4.4±2.9，6.1±2.4对4.8±2，6.1±2. .2对4.5±2.3；P<0.05）。55例患者（80.9%）能够勃起；51例患者（75%）具有插入能力。3例患者（5.5%）完全无法勃起和进行性交。9例患者（13.2%）出现逆行射精。性欲和总体满意度等国际勃起功能指数领域分别在39例患者（57.4%）和43例患者（63.2%）中大幅下降。对影响术后性功能的因素进行多元回归分析显示，年龄大于60岁（性欲，P = 0.019）、手术在六个月内（勃起功能，P = 0.04；性交满意度，P = 0.011；性高潮功能，P = 0.03）、低位直肠癌（勃起功能，P = 0.02；性交满意度，P = 0.036；性高潮功能，P = 0.027）是对性功能产生不利影响的重要因素。
保留盆腔自主神经的全直肠系膜切除术在保留性功能和排尿功能方面显示出相对安全性。国际前列腺症状评分和国际勃起功能指数问卷在评估排尿和性功能方面很有用。
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