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刘帛岩, 冯子夜, 陈玉辉, 胡时栋, 杨星朋, 李松岩. 盆腔自主神经监测对腹腔镜辅助中低位直肠癌根治术中男性患者排尿功能保护作用的研究[J]. 解放军医学院学报. DOI: 10.12435/j.issn.2095-5227.2023.148
引用本文: 刘帛岩, 冯子夜, 陈玉辉, 胡时栋, 杨星朋, 李松岩. 盆腔自主神经监测对腹腔镜辅助中低位直肠癌根治术中男性患者排尿功能保护作用的研究[J]. 解放军医学院学报. DOI: 10.12435/j.issn.2095-5227.2023.148
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LIU Boyan, FENG Ziye, CHEN Yuhui, HU Shidong, YANG Xingpeng, LI Songyan. Protective effect of pelvic autonomic nerve monitoring on urinary function in male patients undergoing laparoscope-assisted radical resection for middle and low rectal cancer[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL. DOI: 10.12435/j.issn.2095-5227.2023.148
Citation: LIU Boyan, FENG Ziye, CHEN Yuhui, HU Shidong, YANG Xingpeng, LI Songyan. Protective effect of pelvic autonomic nerve monitoring on urinary function in male patients undergoing laparoscope-assisted radical resection for middle and low rectal cancer[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL. DOI: 10.12435/j.issn.2095-5227.2023.148
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盆腔自主神经监测对腹腔镜辅助中低位直肠癌根治术中男性患者排尿功能保护作用的研究

Protective effect of pelvic autonomic nerve monitoring on urinary function in male patients undergoing laparoscope-assisted radical resection for middle and low rectal cancer

    摘要
  • 摘要:
    背景 中低位直肠癌由于肿瘤位置较深，容易出现术中盆腔自主神经损伤从而导致患者术后出现排尿功能障碍，寻找降低术中自主神经损伤的方法至关重要。
    目的 通过应用术中盆腔自主神经监测，探讨其对男性患者排尿功能的保护作用，以及降低术中盆腔自主神经(PANP)损伤发生率的应用价值。
    方法 回顾性分析2017年5月至2019年5月就诊于解放军总医院第一医学中心并接受腹腔镜辅助中低位直肠癌根治术的男性患者临床资料，根据是否行术中盆腔自主神经监测分为监测组和对照组。共纳入患者81例，其中监测组41例(双侧成功监测组31例，单侧成功监测组10例)，对照组40例。比较患者围术期指标以及手术前后排尿功能变化。
    结果 三组患者在年龄、肿瘤T分期、N分期、肿瘤直径、分化程度、肿瘤距肛门距离、手术时间、术中出血量、术式等指标差异无统计学意义(P＞0.05)。双侧监测组及单侧监测组术后留置导尿管时间均小于对照组(59.81 ± 34.67) h和(84.50 ± 25.43) h vs (115.73 ± 50.53) h，P＜0.05。双侧监测组及单侧监测组国际前列腺症状评分(IPSS)术后1个月M(IQR)：5.0(2.0，8.0)和4.0(1.3，6.8) vs 6.0(1.0，11.0)，P均＜0.05及术后1年均优于对照组3.0(1.0，5.0)和3.0(0.5，5.5) vs 4.5(0.5，8.5)，P均＜0.05。双侧监测组及单侧监测组术后1个月及术后1年生活质量评分(QoL)均优于对照组M(IQR)：3.0(2.0，4.0)和2.5(1.3，3.8) vs 3.0(2.0，4.0)，P均＜0.05；2.0(1.0，3.0)和2.0(0.8，3.3) vs 3.0(2.0，4.0)，P均＜0.05。此外，监测组术前及术后1年IPSS评分及QoL评分差异无统计学意义(P＞0.05)，而对照组术前及术后1年IPSS评分及QoL评分差异具有统计学意义(P＜0.05)。
    结论 腹腔镜辅助中低位直肠癌根治术中应用术中盆腔自主神经监测对男性患者排尿功能具有保护作用，降低了患者术中盆腔自主神经损伤的风险，改善了患者的生活质量。

     

    Abstract:
    Background Due to the deep location of middle and low rectal cancer, intraoperative pelvic autonomic nerve injury is likely to occur, resulting in postoperative urination dysfunction in patients. Therefore, it is very important to find ways to reduce intraoperative autonomic nerve injury.
    Objective To investigate the protective effect of intraoperative monitoring of pelvic autonomic nerves (IMPAN) on urination function in male patients and its application value in reducing the incidence of intraoperative pelvic autonomic nerve injury.
    Methods Clinical data about male patients who underwent laparoscopic-assisted radical resection of mid-low rectal cancer at the First Medical Center of Chinese PLA General Hospital from May 2017 to May 2019 were retrospectively analyzed. The patients were divided into surveillance group and control group according to whether they underwent IMPAN or not. A total of 81 patients were enrolled, including 41 cases in the monitoring group (31 in the bilateral successful monitoring group and 10 in the unilateral successful monitoring group) and 40 cases in the control group. The changes of urination function before and after surgery were compared by comparing the perioperative data and urination function related factors of the three groups.
    Results There were no significant differences in age, tumor category, lymphatic metastasis, diameter of tumor, degree of differentiation, distance from tumor to anus, operation time, intraoperative blood loss and type of operation among the three groups (P＞0.05). The time of indwelling catheter in bilateral monitoring group and unilateral monitoring group were shorter than that in control group (59.81 ± 34.67 h, 84.50 ± 25.43 h vs 115.73 ± 50.53 h, P＜0.05). The International prostate symptom score (IPSS) of the bilateral monitoring group and the unilateral monitoring group was better than that of the control group at 1 month and 1 year after surgery (5.0 2.0, 8.0, and 4.0 1.3, 6.8 vs 6.0 1.0, 11.0, P<0.05; 3.0 1.0, 5.0, and 30.5, 5.5 vs 4.5(0.5, 8.5), P<0.05). The quality of life scores (QoL) of the bilateral monitoring group and the unilateral monitoring group at 1 month and 1 year after surgery were better than those of the control group (3.0 2.0, 4.0 and 2.51.3, 3.8 vs 3.0 2.0, 4.0, P<0.05; 2.0 1.0, 3.0 and 20.8, 3.3 vs 3.0 2.0, 4.0, P<0.05). In addition, there was no significant difference in the IPSS score and QoL score before and 1 year after operation in the monitoring group (P>0.05), while there was significant difference in the IPSS score and QoL score before and 1 year after operation in the control group (P< 0.05).
    Conclusion The application of IMPAN in laparoscopic-assisted radical resection of mid-low rectal cancer can protect the urination function of male patients, reduce the risk of intraoperative pelvic autonomic nerve injury, and improve the quality of life of patients.

     

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