Xenos E S, Stevens S L, Freeman M B, Pacanowski J P, Cassada D C, Goldman M H
Department of Surgery, University of Tennessee, Knoxville, TN 37920, USA.
Ann Vasc Surg. 2003 Sep;17(5):530-8. doi: 10.1007/s10016-003-0058-2. Epub 2003 Sep 29.
Open abdominal aortic aneurysm repair has been reported to be associated with impairment of sexual function in men, most likely because of autonomic nerve injury and pelvic blood flow changes. Endovascular aneurysm repair does not involve dissection in the area of the iliac bifurcation and therefore may be associated with lower incidence of sexual dysfunction as compared to open repair. We conducted a retrospective study of males after open and endovascular abdominal aortic aneurysm repair to determine if there is a significant difference in the incidence of sexual dysfunction between the two procedures. A modified International Index of Erectile Function Questionnaire was used to access sexual function before and after aneurysm repair. The questionnaire was mailed to all male patients who underwent abdominal aortic aneurysm repair from January 1, 1999 to July 15, 2002. The questionnaire asked patients questions regarding their sexual function before and 3 months after the repair. Questionnaire scores for domains of sexual function (erectile function, orgasmic function, intercourse satisfaction, and overall satisfaction) as well as the total questionnaire score were analyzed. The chi-square and Wilcoxon's signed ranks test were used for statistical comparisons, with p < 0.05 considered significant. Logistic regression was used to examine association. Two hundred ninety-three questionnaires were mailed and 90 were returned completed. There was no difference for the total questionnaire score or the erectile function score before the procedure. Based on the questionnaire score, erectile function worsened after open AAA repair ( p = 0.002). Orgasmic function also deteriorated after open AAA repair ( p = 0.001). Endovascular repair was not accompanied by decreased erectile or orgasmic function ( p = 0.057 and p = 0.068, respectively). Impairment of erectile function was not associated with age, diabetes, or the number of patent hypogastric arteries after aneurysm repair, but there was a significant association between impaired erectile function and open aneurysm repair ( p = 0.036). Endovascular repair of abdominal aortic aneurysms is associated with significantly less impairment of erectile and orgasmic function than that with open repair. Preservation of sexual function after endovascular as compared to open repair should be among the factors considered when weighing treatment options for an abdominal aortic aneurysm in a sexually active male.
据报道，开放性腹主动脉瘤修复术与男性性功能障碍有关，最可能的原因是自主神经损伤和盆腔血流变化。血管内动脉瘤修复术不涉及髂动脉分叉区域的解剖，因此与开放性修复相比，性功能障碍的发生率可能较低。我们对接受开放性和血管内腹主动脉瘤修复术的男性进行了一项回顾性研究，以确定这两种手术在性功能障碍发生率上是否存在显著差异。使用改良的国际勃起功能指数问卷来评估动脉瘤修复术前和术后的性功能。该问卷被邮寄给了所有在1999年1月1日至2002年7月15日期间接受腹主动脉瘤修复术的男性患者。问卷询问了患者修复术前和术后3个月的性功能问题。分析了性功能领域（勃起功能、性高潮功能、性交满意度和总体满意度）的问卷得分以及问卷总分。采用卡方检验和威尔科克森符号秩检验进行统计学比较，p<0.05被认为具有显著性。使用逻辑回归分析关联性。共邮寄了293份问卷，90份问卷被完整返回。手术前问卷总分或勃起功能得分没有差异。根据问卷得分，开放性腹主动脉瘤修复术后勃起功能恶化（p = 0.002）。开放性腹主动脉瘤修复术后性高潮功能也恶化（p = 0.001）。血管内修复术并未伴随勃起或性高潮功能下降（分别为p = 0.057和p = 0.068）。勃起功能障碍与年龄、糖尿病或动脉瘤修复术后下腹动脉通畅数量无关，但勃起功能障碍与开放性动脉瘤修复术之间存在显著关联（p = 0.036）。与开放性修复相比，腹主动脉瘤的血管内修复术导致的勃起和性高潮功能障碍明显较少。在为性活跃男性权衡腹主动脉瘤的治疗方案时，血管内修复术与开放性修复术相比对性功能的保留应作为考虑因素之一。
