Laparoscopic Pelvic Autonomic Nerve-Preserving Surgery for Sigmoid Colon Cancer_West China Medical Journal

Authors：

WU Miao , YANG Jian , LIU Jian , DENG Xiaodong , ZHENG Tao , LIU Shicheng , CHEN Liheng .

The Second People’s Hospital of Yibin, Yibin, Sichuan 644000, P. R. China;

Corresponding author：

Keywords：

腹腔镜; 乙状结肠癌; 盆腔自主神经

DOI：

10.7507/1002-0179.20130316

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目的　探讨腹腔镜下乙状结肠癌根治术保留盆腔自主神经的可行性及对术后泌尿、生殖功能的影响。方法　选取2007年8月－2009年7月60例行腹腔镜下乙状结肠癌根治术患者，手术按标准腹腔镜下乙状结肠癌前切除手术方式操作。术后采用问卷调查方式对患者术后泌尿功能、男性勃起功能、女性性功能进行效果评价。生殖泌尿功能评估包含国际前列腺增生评分（IPSS）、国际勃起功能评分量表（IIEF）、女性性功能评估量表（FSFI）。结果　58例患者成功保留自主神经，56例接受术后泌尿、生殖功能测定，置放尿管时间为1～7 d，平均3 d，拔除尿管后排尿功能良好（IPSS 0～7分）57例（95.0%），一般（IPSS 8～14分）2例（3.3%），差（IPSS 15～35分）1例（1.7%），术前、术后IPSS评分差异无统计学意义（P=0.075）。30例男性患者术后，射精良好27例（90.0%），一般2例（6.7%），差1例（3.3%）；但是勃起功能测定良好（IIEF 60～75分）28例（93.4%），一般（IIEF 44～59分）1例（3.3%），差（IIEF 5～43分）1例（3.3%），术前、术后IIEF差异无统计学意义。26例女性患者术后性功能评分，良好（FSFI 76～95分） 23例（88.5%），一般（FSFI 58～75分） 2例（7.7%），差（FSFI 4～57分）1例（3.8%）。盆腔神经保留成功的患者术前、术后差异无统计学意义（P=0.122）。结论　多数腹腔镜下乙状结肠癌根治术患者能有效保留盆腔自主神经，且术后能保留泌尿、生殖功能。

Citation： WU Miao,YANG Jian,LIU Jian,DENG Xiaodong,ZHENG Tao,LIU Shicheng,CHEN Liheng .. Laparoscopic Pelvic Autonomic Nerve-Preserving Surgery for Sigmoid Colon Cancer. West China Medical Journal, 2013, 28(7): 1021-1024. doi: 10.7507/1002-0179.20130316 Copy

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2.	Matsumoto T, Ohue M, Sekimoto M, et al. Feasibility of autonomic nerve-preserving surgery for advanced rectal cancer based on analysis of micrometastases[J]. Br J Surg, 2005, 92(11): 1444-1448.
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8.	Liang JT, Lai HS, Lee PH. Laparoscopic pelvic autonomic nerve-preserving surgery for patients with lower rectal cancer after chemoradiation therapy[J]. Ann Surg Oncol, 2007, 14(4): 1285-1287.
9.	Liang JT, Chang KJ, Wang SM. Anatomical basis of autonomic nerve-preserving total mesorectal excision for rectal cancer[J]. Br J Surg, 1997, 84(4): 586-587.
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11.	Walsh PC, Schlegel PN. Radical pelvic surgery with preservation of sexual function[J]. Ann Surg, 1988, 208(4): 391-400.
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14.	谭敏, 郭宝贤, 吴志棉, 等. 经腹腔镜结直肠癌切除术[J]. 中华外科杂志, 2002, 40(10): 769-772.
15.	王秋生. 腹腔镜胃肠外科[J]. 腹腔镜外科杂志, 2002, 7(1): 1.
16.	Rosen RC, Riley A, Wagner G, et al. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction[J]. Urology, 1997, 49(6): 822-830.
17.	Rosen R, Brown C, Heiman J, et al. The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function[J]. J Sex Marital Ther, 2000, 26(2): 191-208.
18.	顾晋, 马朝来, 夏家骝, 等. 直肠癌根治术中保留骨盆自主神经的神经解剖学基础及临床意义[J]. 中华外科杂志, 2000, 38(2): 128-130.
19.	赵沨, 施培友. 直肠癌TME 术中保留盆腔自主神经对男性性功能及排尿功能的影响[J]. 中国普外基础与临床杂志, 2011, 18(2): 191-195.
20.	鲁发龙, 杜刚毅, 郑少康, 等. 直肠癌根治术保留自主神经56例临床体会[J]. 结直肠肛门外科, 2009, 15(2): 83-84.
21.	顾晋, 李学松. 保留盆腔自主神经的直肠癌手术对男性排尿及性功能的影响[J]. 中华胃肠外科杂志, 2001, 4(2): 126-128.
22.	杨映弘, 颜璟, 蔺原, 等. 腹腔镜全直肠系膜切除术盆腔自主神经保留对术后性功能的影响[J]. 中国普外基础与临床杂志, 2008, 15(10): 726-727.
23.	Saito N, Koda K, Nobuhiro K, et al. Nerve-sparing surgery for advanced rectal cancer patients: special reference to Dukes C patients[J]. World J Surg, 1999, 23(10): 1062-1068.
24.	梁德森, 姜涛, 张铁民, 等. 直肠癌手术中保留盆腔自主神经的意义[J]. 中华普通外科杂志, 2006, 21(7): 511-513.

1. 　Hendren SK, O’Connor BI, Liu M, et al. Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer[J]. Ann Surg, 2005, 242(2): 212-223.
2. 　Matsumoto T, Ohue M, Sekimoto M, et al. Feasibility of autonomic nerve-preserving surgery for advanced rectal cancer based on analysis of micrometastases[J]. Br J Surg, 2005, 92(11): 1444-1448.
3. 　Shirouzu K, Ogata Y, Araki Y. Oncologic and functional results of total mesorectal excision and autonomic nerve-preserving operation for advanced lower rectal cancer[J]. Dis Colon Rectum, 2004, 47(9): 1442-1447.
4. 　Sugihara K, Moriya Y, Akasu T, et al. Pelvic autonomic nerve preservation for patients with rectal carcinoma. Oncologic and functional outcome[J]. Cancer, 1996, 78(9): 1871-1880.
5. 　Kim NK, Aahn TW, Park JK, et al. Assessment of sexual and voiding function after total mesorectal excision with pelvic autonomic nerve preservation in males with rectal cancer[J]. Dis Colon Rectum, 2002, 45(9): 1178-1185.
6. 　Moriya Y. Function preservation in rectal cancer surgery[J]. Int J Clin Oncol, 2006, 11(5): 339-343.
7. 　Platell CF, Thompson PJ, Makin GB. Sexual health in women following pelvic surgery for rectal cancer[J]. Br J Surg, 2004, 91(4): 465-468.
8. 　Liang JT, Lai HS, Lee PH. Laparoscopic pelvic autonomic nerve-preserving surgery for patients with lower rectal cancer after chemoradiation therapy[J]. Ann Surg Oncol, 2007, 14(4): 1285-1287.
9. 　Liang JT, Chang KJ, Wang SM. Anatomical basis of autonomic nerve-preserving total mesorectal excision for rectal cancer[J]. Br J Surg, 1997, 84(4): 586-587.
10. 　Liang JT, Chien CT, Chang KJ, et al. Neurophysiological basis of sympathetic nerve-preserving surgery for lower rectal cancer-a canine model[J]. Hepatogastroenterology, 1998, 45(24): 2206-2214.
11. 　Walsh PC, Schlegel PN. Radical pelvic surgery with preservation of sexual function[J]. Ann Surg, 1988, 208(4): 391-400.
12. 　Jayne DG, Brown JM, Thorpe H, et al. Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique[J]. Br J Surg, 2005, 92(9): 1124-1132.
13. 　牟一平, 杨鹏, 严加费, 等. 腹腔镜结肠癌根治术的临床疗效评估[J]. 中华外科杂志, 2006, 44(9): 581-583.
14. 　谭敏, 郭宝贤, 吴志棉, 等. 经腹腔镜结直肠癌切除术[J]. 中华外科杂志, 2002, 40(10): 769-772.
15. 　王秋生. 腹腔镜胃肠外科[J]. 腹腔镜外科杂志, 2002, 7(1): 1.
16. 　Rosen RC, Riley A, Wagner G, et al. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction[J]. Urology, 1997, 49(6): 822-830.
17. 　Rosen R, Brown C, Heiman J, et al. The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function[J]. J Sex Marital Ther, 2000, 26(2): 191-208.
18. 　顾晋, 马朝来, 夏家骝, 等. 直肠癌根治术中保留骨盆自主神经的神经解剖学基础及临床意义[J]. 中华外科杂志, 2000, 38(2): 128-130.
19. 　赵沨, 施培友. 直肠癌TME 术中保留盆腔自主神经对男性性功能及排尿功能的影响[J]. 中国普外基础与临床杂志, 2011, 18(2): 191-195.
20. 　鲁发龙, 杜刚毅, 郑少康, 等. 直肠癌根治术保留自主神经56例临床体会[J]. 结直肠肛门外科, 2009, 15(2): 83-84.
21. 　顾晋, 李学松. 保留盆腔自主神经的直肠癌手术对男性排尿及性功能的影响[J]. 中华胃肠外科杂志, 2001, 4(2): 126-128.
22. 　杨映弘, 颜璟, 蔺原, 等. 腹腔镜全直肠系膜切除术盆腔自主神经保留对术后性功能的影响[J]. 中国普外基础与临床杂志, 2008, 15(10): 726-727.
23. 　Saito N, Koda K, Nobuhiro K, et al. Nerve-sparing surgery for advanced rectal cancer patients: special reference to Dukes C patients[J]. World J Surg, 1999, 23(10): 1062-1068.
24. 　梁德森, 姜涛, 张铁民, 等. 直肠癌手术中保留盆腔自主神经的意义[J]. 中华普通外科杂志, 2006, 21(7): 511-513.

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