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Initial Research on the Influence of Urinary Function and Sexual Function after Pelvic Autonomic Nerves Preservation (PANP) and Total Mesorectal Excision (TME)

Author: WangXuZuo
Tutor: HuangGuiLin
School: Shihezi University
Course: Surgery
Keywords: Advanced rectal cancer Pelvic autonomic nerve preservation Voiding Dysfunction Sexual dysfunction
CLC: R735.37
Type: Master's thesis
Year: 2008
Downloads: 43
Quote: 0
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Abstract


The main purpose for advanced rectal cancer treatment surgery, total mesorectal excision is the world's gold standard mode of operation for the treatment of rectal cancer, but inevitably will occur due to the pelvic autonomic nerve damage during surgery, patients with postoperative urinary function and sexual dysfunctions. The purpose of this study is that observed analysis of radical pelvic autonomic nerve preservation (PANP) in total mesorectal excision (TME), based on the uplink resection for rectal cancer in patients with long-term urinary function (after three months), and the male rectum cancer sexual function (after three months). PATIENTS AND METHODS First Affiliated Hospital of Shihezi University School of Medicine gastrointestinal Breast Surgery retrospective analysis of 43 cases of rectal cancer patients treated since March 2004 to December 2007, which accepted of TME PANP surgery (10 women, 17 for men cases), accept TME non-reserved pelvic autonomic nervous radical mastectomy in 16 patients (male). Detailed to collect general information on each patient to accept the TME PANP patients undergoing preoperative urinary function (urodynamic) and male patients with preoperative functional information. The two groups of male patients in the diseased parts, Dukes stage, surgical approach match. All patients with no preoperative radiotherapy and chemotherapy. The line PANP surgery the TME principle based. Sharp separation of the rectal wall under direct vision, attention to enter the correct gap separating the rectum. Intraoperative attention to the location of the autonomic nervous system and running; whether the tumor invaded nerves surrounding lymph node metastasis and decide whether nerve-sparing surgery. The main reservation nerve: ① The hypogastric plexus; ② hypogastric nerve; ③ pelvic plexus; ④ the pelvic splanchnic nerve. Observe the following: ① to accept TME PANP surgery patients (13 males, 10 females) and the preoperative examination urinary function after three months later urinary function (urodynamic studies), collect urine flow rate, residual urine volume . ② postoperative male sexual function: erectile function and ejaculatory function. Erectile dysfunction international index questionnaire (internationalindex of erectile function, IIEF) score about erectile function in urinary function using SPSS for Windows Version 11.0 statistical package for data analysis, self-control before and after surgery, the normal distribution of measurement data using t test, count data using the X2 test set P lt; 0.05 significant difference. Sexual function using social science statistical package (Statistical package for social sciences, SPSS) For Windows 12.0 packet analysis. The two sets of data comparison: measurement data with the t test, count data using the X2 test or Fisher's exact level data with the the scoring rank sum test, the level of information in accordance with the appropriate level score, P lt; 0.05 for the difference was statistically significant . Compare the results of to ① postoperative urinary function: 23 cases of patients with preoperative and postoperative urinary flow rate, residual urine volume urinary flow rate (P = 0.134), and residual urine volume (P = 0.141) difference was not statistically significant (P gt; 0.05). ② postoperative erectile function: reserved pelvic autonomic nervous group IIEF the 1,2 score higher than on non-retention group (P = 0.033) difference was statistically significant (P lt; 0.05). Ejaculatory function better than the non-retention group (P = 0.032) difference was statistically significant (P lt; 0.05). Conclusion advanced rectal cancer radical surgery for pelvic autonomic nerve preservation, retention in patients with urinary function, and for male patients with non-pelvic autonomic nerve preservation group compared to the male sexual function can be better protected.

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CLC: > Medicine, health > Oncology > Gastrointestinal Cancer > Intestinal neoplasms > Rectal cancer
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