| Objective: In this study,we compared the laparoscopic total mesorectal excision(TME)of reserved the left colonic artery and pelvic autonomic nerve and traditional open TME,to evaluate the protective effect of postoperative urinary function and sexual function and the impact on postoperative complications.Methods:This study was a prospective randomized controlled trial of 52 male patients with rectal cancer treated between August 2015 and February 2018,divided into observation group and control group.The observation group of 27 cases received laparoscopic TME retained the left colic artery and pelvic autonomic nervous,the control group of 25 patients received traditional open TME.Two groups of patients with rectal cancer were selected Dixon.Observe the length of hospital stay,operation time,intraoperative blood loss,the first postoperative exhaust time,postoperative catheter removal time,the number of lymph node dissection,the incidence of anastomotic leakage and other indicators,the postoperative international sexual function and urinary function were evaluated by the International Prostate Symptom Score(IPSS)score and postoperative international erectile function index(IIEF-5)questionnaire.At 3 months and 6 months after operation,the patients' sexual function was followed up by IPSS questionnaire,three months after surgery,the urological function of patients was followed up by the International Index of Erectile Function Inventory.Observation of the effect of two groups of operation on the quality of life of the patients after operation.Statistical methods SPSS20.0 software for statistical analysis.Results:The observation group and control group,a total of 52 patients,the operation was successfully carried out.In the follow-up period,one of the 27 patients in the observation group was lost,and one patient did not try to recover their sexual life after being discharged from the hospital.One of the 25 patients in the control group found a recurrence of the tumor after the operation.One case was lost,and one patient did not try to restore sexual life.In the observation group,the hospitalization time was 17.15 ± 1.90d(14-20d),the operation time was 226.67 ± 56.57min(160-420min),the intraoperative blood loss was 31.85 ± 11.02ml(20-80ml)and the postoperative ventilation time was 2.89±1.05d(1-6d),catheter removal time was 3.78±0.70d(3-7d),anastomotic fistula occurred in 1 case,the incidence was 4.55%,the number of lymph nodes dissection was 18.7 ± 3.69(12-25).In the control group,the hospital stay was 17.20±3.16 days(14-30 days),the operation time was 218.80±56.51 minutes(130-370 minutes),the blood loss was 123.60 ± 26.12ml(80-200ml)and the postoperative ventilation time was 3.64±1.04 days(2-6d).The duration of catheter removal was 4.48±1.16 days(3-8 days).No anastomotic fistula occurred after operation.The number of lymph nodes dissected was 18.56±4.51(12-26).The P values calculated by T test of two groups of samples were0.943,0.618,0.000,0.012,0.010,0.481,0.900,there was no significant difference between the two groups in hospitalization time,operation time,intraoperative blood loss,incidence of anastomotic leakage and number of lymph node dissection(P> 0.05).There was a significant difference between the two groups of data between the blood loss,the time of postoperative ventilation and the time of removing the catheter(P<0.05).Sexual function was assessed by the International Index of Erectile Function(IIEF-5).In the first follow-up 3 months after surgery,the observation group of 25 patients,17 patients were normal,no erectile dysfunction(22-25 points),accounting for 68.0%,there were 6 cases of mild erectile dysfunction(12-21 points),2 cases of moderate erectile dysfunction(8-11 points),no severe erectile dysfunction(5-7 points),and sexual dysfunction The rate is 32.0%.the control group of 22 patients,12 patients were normal,no erectile dysfunction(22-25 points),accounting for 54.5%,there were 6 cases of mild erectile dysfunction(12-21 points),4 cases of moderate erectile dysfunction(8-11 points),no severe erectile dysfunction(5-7 points),and sexual dysfunction The rate is 45.5%.The incidence of sexual dysfunction in the control group was higher than that in the observation group,but the statistical analysis showed that the P value was 0.344 between the two groups(P> 0.05).At the second follow-up six months after surgery,the observation group of 25 patients,21 patients were normal,no erectile dysfunction(22-25 points),accounting for 84.0%,there were 3 cases of mild erectile dysfunction(12-21 points),1 cases of moderate erectile dysfunction(8-11 points),no severe erectile dysfunction(5-7 points),and sexual dysfunction The rate is 16%.the control group of 22 patients,16 patients were normal,no erectile dysfunction(22-25 points),accounting for 73.7%,there were 4 cases of mild erectile dysfunction(12-21 points),2 cases of moderate erectile dysfunction(8-11 points),no severe erectile dysfunction(5-7 points),and sexual dysfunction The rate is 27.3%.The incidence of sexual dysfunction in the control group was higher than that in the observation group,but the statistical analysis showed that the P value was 0.558 between the two groups(P> 0.05).The indicators for assessing postoperative urinary function were postoperative catheter removal time and International Prostate Symptom Score(IPSS)questionnaire.The postoperative catheter removal time was compared between the two groups with a P value of 0.01 and a statistically significant difference(P <0.05),therefore,the two groups in the short-term postoperative urinary function observation group was better than the control group.Two groups of International Prostate Symptom Score(IPSS)score,the patient score of 0,defined as normal urination in patients with urinary function.Two groups of International Prostate Symptom Score(IPSS)scoring results:In the observation group,18 cases of normal urinary function,accounting for 72.0%,5 cases of mild voiding dysfunction(1-7 points),2 cases of moderate Degree of urinary dysfunction(8-19 points),no patients with severe urinary dysfunction(20-35 points),the incidence of urinary dysfunction was 28.0%.In the control group,14 cases of normal urinary function,accounting for 63.6%,5 cases of mild voiding dysfunction(1-7 points),3 cases of moderate Degree of urinary dysfunction(8-19 points),no patients with severe urinary dysfunction(20-35 points),the incidence of urinary dysfunction was 36.4%.The incidence of micturition dysfunction in the control group was higher than that in the observation group.However,the statistical analysis showed that the P value was 0.539 between the two groups(P> 0.05).There was no difference in the long-term urinary function between the two groups.Conclusion:The laparoscopic total mesorectal excision(TME)of reserved the left colonic artery and pelvic autonomic nerve can effectively reduce the blood loss,postoperative ventilation time and catheterization time,reduce the incidence of anastomotic fistula to ensure the number of lymph node dissection,the patient's recent urination function has a good protective effect.In terms of long-term urinary function,it effectively reduces the incidence of urinary dysfunction,postoperative sexual function,but also reduces the incidence of sexual dysfunction,but no significant difference between the two groups. |
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