Division of Abdomino-Pelvic Surgery, European Institute of Oncology, Milano, Italy.
Ann Surg. 2013 Apr;257(4):672-8. doi: 10.1097/SLA.0b013e318269d03b.
Urinary and sexual dysfunctions are recognized complications of rectal cancer surgery. Their incidence after robotic surgery is as yet unknown. The aim of this study was to prospectively evaluate the impact of robotic surgery for rectal cancer on sexual and urinary functions in male and female patients.
From April 2008 to December 2010, 74 patients undergoing fully robotic resection for rectal cancer were prospectively included in the study. Urinary and sexual dysfunctions affecting quality of life were assessed with specific self-administered questionnaires in all patients undergoing robotic total mesorectal excision (RTME). Results were calculated with validated scoring systems and statistically analyzed.
The analyses of the questionnaires completed by the 74 patients who underwent RTME showed that sexual function and general sexual satisfaction decreased significantly 1 month after intervention: 19.1 ± 8.7 versus 11.9 ± 10.2 (P < 0.05) for erectile function and 6.9 ± 2.4 versus 5.3 ± 2.5 (P < 0.05) for general satisfaction in men; 2.6 ± 3.3 versus 0.8 ± 1.4 (P < 0.05) and 2.4 ± 2.5 versus 0.7 ± 1.6 (P < 0.05) for arousal and general satisfaction, respectively, in women. Subsequently, both parameters increased progressively, and 1 year after surgery, the values were comparable to those measured before surgery. Concerning urinary function, the grade of incontinence measured 1 year after the intervention was unchanged for both sexes.
RTME allows for preservation of urinary and sexual functions. This is probably due to the superior movements of the wristed instruments that facilitate fine dissection, coupled with a stable and magnified view that helps in recognizing the inferior hypogastric plexus.
尿失禁和性功能障碍是直肠癌手术后公认的并发症。机器人手术后的发病率尚不清楚。本研究的目的是前瞻性评估机器人手术对男性和女性直肠癌患者的性功能和尿功能的影响。
2008 年 4 月至 2010 年 12 月，74 例接受全直肠系膜切除术（RTME）的直肠癌患者前瞻性纳入研究。所有接受机器人全直肠系膜切除术（RTME）的患者均采用特定的自我管理问卷评估对生活质量有影响的尿失禁和性功能障碍。使用经过验证的评分系统计算结果并进行统计学分析。
对 74 例行 RTME 的患者完成的问卷进行分析，结果显示，1 个月后，男性的性功能和总体性满意度显著下降：勃起功能为 19.1 ± 8.7 比 11.9 ± 10.2（P < 0.05）；总体满意度为 6.9 ± 2.4 比 5.3 ± 2.5（P < 0.05）。女性的性唤起和总体满意度分别为 2.6 ± 3.3 比 0.8 ± 1.4（P < 0.05）和 2.4 ± 2.5 比 0.7 ± 1.6（P < 0.05）。随后，这两个参数逐渐增加，手术后 1 年，其值与术前测量值相当。关于尿功能，手术后 1 年，男女失禁程度不变。
RTME 可以保留尿和性功能。这可能是由于腕式器械的运动更灵活，有利于精细解剖，再加上稳定且放大的视野，有助于识别下腹下丛。
