Ameda Kaname, Kakizaki Hidehiro, Koyanagi Tomohiko, Hirakawa Kazushi, Kusumi Takaya, Hosokawa Masao
Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Int J Urol. 2005 Mar;12(3):256-63. doi: 10.1111/j.1442-2042.2005.01026.x.
The aim of the present study is to symptomatically analyze the extent to which pelvic nerve-sparing radical surgery for rectal cancer impacts on long-term voiding and male sexual function.
A self-administered questionnaire was mailed to 68 patients who underwent pelvic nerve-sparing radical surgery for invasive rectal cancer with 52 responses (28 men and 24 women; 27 complete and 25 incomplete preservation; response rate 76.5%). Each patient was asked to record if there had been any changes in lower urinary tract symptoms after surgery. Sexual function was also investigated in men.
Of the 52 patients, 48 (92%) maintained voluntary voiding without catheterization in the long term. Clean intermittent self-catheterization was performed in only four patients with incomplete preservation because of persistent voiding dysfunction. Subjectively, approximately 60% of the patients remained unchanged in lower urinary tract symptoms after surgery. The satisfaction rate regarding the current voiding status was significantly higher in women than in men (83% versus 61%, P = 0.0294), but was not significantly different between those with complete (76%) and incomplete preservation (64%). Despite the acceptable urinary status, 88% of men had some deterioration in the erectile function, regardless of the types of surgical procedures. Overall, 64% of men were unsatisfied with the current sexual function.
Pelvic nerve-sparing radical surgery for rectal cancer preserved the long-term voiding function in the majority of patients. In completely preserved patients and in women, symptomatic outcomes were more satisfactory. Postoperative erectile dysfunction was found to be a serious problem, even in complete nerve-sparing procedure.
本研究旨在对直肠癌保留盆腔神经的根治性手术对长期排尿及男性性功能的影响程度进行症状分析。
向68例行保留盆腔神经根治性手术治疗浸润性直肠癌的患者邮寄了一份自填式问卷，共收到52份回复（28名男性和24名女性；27例完全保留和25例不完全保留；回复率76.5%）。每位患者被要求记录术后下尿路症状是否有任何变化。还对男性的性功能进行了调查。
52例患者中，48例（92%）长期维持自主排尿，无需导尿。仅4例不完全保留患者因持续性排尿功能障碍而进行清洁间歇性自家导尿。主观上，约60%的患者术后下尿路症状无变化。女性对当前排尿状况的满意率显著高于男性（83%对61%，P = 0.0294），但完全保留（76%）和不完全保留患者（64%）之间无显著差异。尽管排尿状况尚可，但88%的男性勃起功能有一定程度的恶化，无论手术方式如何。总体而言，64%的男性对当前性功能不满意。
直肠癌保留盆腔神经的根治性手术在大多数患者中保留了长期排尿功能。在完全保留的患者和女性中，症状性结果更令人满意。发现术后勃起功能障碍是一个严重问题，即使在完全保留神经的手术中也是如此。
