Lange M M, Maas C P, Marijnen C A M, Wiggers T, Rutten H J, Kranenbarg E Klein, van de Velde C J H
Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
Br J Surg. 2008 Aug;95(8):1020-8. doi: 10.1002/bjs.6126.
Urinary dysfunction (UD) is common after rectal cancer treatment, but the contribution of each treatment component (surgery and radiotherapy) to its development remains unclear. This study aimed to evaluate UD during 5 years after total mesorectal excision (TME) and to investigate the influence of preoperative radiotherapy (PRT) and surgical factors.
Patients with operable rectal cancer were randomized to TME with or without PRT. Questionnaires concerning UD were completed by 785 patients before and at several time points after surgery. Possible risk factors, including PRT, demographics, tumour location, and type and extent of resection, were investigated by multivariable regression analysis.
Long-term incontinence was reported by 38.1 per cent of patients, of whom 72.0 per cent had normal preoperative function. Preoperative incontinence (relative risk (RR) 2.75, P = 0.001) and female sex (RR 2.77, P < 0.001) were independent risk factors. Long-term difficulty in bladder emptying was reported by 30.6 per cent of patients, of whom 65.0 per cent had normal preoperative function. Preoperative difficulty in bladder emptying (RR 2.94, P < 0.001), peroperative blood loss (RR 1.73, P = 0.028) and autonomic nerve damage (RR 2.82, P = 0.024) were independent risk factors. PRT was not associated with UD.
UD is a significant clinical problem after rectal cancer treatment and is not related to PRT, but rather to surgical nerve damage.
直肠癌治疗后尿功能障碍（UD）很常见，但每种治疗成分（手术和放疗）对其发生发展的作用仍不明确。本研究旨在评估全直肠系膜切除术（TME）后5年内的UD情况，并调查术前放疗（PRT）和手术因素的影响。
将可手术切除的直肠癌患者随机分为接受或不接受PRT的TME组。785例患者在手术前及术后多个时间点完成了关于UD的问卷调查。通过多变量回归分析研究可能的危险因素，包括PRT、人口统计学特征、肿瘤位置以及切除类型和范围。
38.1%的患者报告有长期尿失禁，其中72.0%术前功能正常。术前尿失禁（相对危险度（RR）2.75，P = 0.001）和女性（RR 2.77，P < 0.001）是独立危险因素。30.6%的患者报告有长期膀胱排空困难，其中65.0%术前功能正常。术前膀胱排空困难（RR 2.94，P < 0.001）、术中失血（RR 1.73，P = 0.028）和自主神经损伤（RR 2.82，P = 0.024）是独立危险因素。PRT与UD无关。
UD是直肠癌治疗后的一个重要临床问题，与PRT无关，而与手术神经损伤有关。
