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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2017, Vol. 11 ›› Issue (05) : 344 -348. doi: 10.3877/cma.j.issn.1674-3253.2017.05.013

所属专题： 文献；

临床研究

神经电刺激在腹腔镜直肠癌根治术患者排尿及性功能保护中的应用
周雪玲1, 方佳峰1, 蔡蕾1, 何晓兰1, 杨运娥1, 粟静1, 黄师菊1, 司徒杰1, 郑宗珩1, 李晓玲1,†()   
  1. 1. 510630　广州，中山大学附属第三医院外科
  • 收稿日期:2017-05-04 出版日期:2017-10-01
  • 通信作者: 李晓玲
  • 基金资助:
    广东省自然科学基金(2015A030313063)

Intra-operative electrical nerve stimulation on preservation of pelvic autonomic nerve during radical laparoscopic proctectomy

Xueling Zhou1, Jiafeng Fang1, Lei Cai1, Xiaolan He1, Yun'e Yang1, Jing Su1, Shiju Huang1, Jie Situ1, Zongheng Zheng1, Xiaoling Li1,†()   

  1. 1. Department of Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2017-05-04 Published:2017-10-01
  • Corresponding author: Xiaoling Li
  • About author:
    Corresponding author: Li Xiaoling, Email:
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引用本文：

周雪玲, 方佳峰, 蔡蕾, 何晓兰, 杨运娥, 粟静, 黄师菊, 司徒杰, 郑宗珩, 李晓玲. 神经电刺激在腹腔镜直肠癌根治术患者排尿及性功能保护中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2017, 11(05): 344-348.

Xueling Zhou, Jiafeng Fang, Lei Cai, Xiaolan He, Yun'e Yang, Jing Su, Shiju Huang, Jie Situ, Zongheng Zheng, Xiaoling Li. Intra-operative electrical nerve stimulation on preservation of pelvic autonomic nerve during radical laparoscopic proctectomy[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2017, 11(05): 344-348.

目的

在腹腔镜直肠癌根治术中应用神经电刺激技术进行盆腔自主神经的监测及保护，探讨该方法对直肠癌患者术后排尿及勃起功能保护的作用。

方法

对中山大学附属第三医院2014年10月至2016年10月收治的92例腹腔镜直肠癌根治术患者进行前瞻性随机对照研究，实验组应用神经电刺激技术进行盆腔自主神经监测及保护，对照组采用肉眼神经辨认及保护。采用超声测定膀胱残余尿（RUV）、国际前列腺症状评分（IPSS）、二次导尿率等指标评估排尿功能；勃起功能国际指数问卷（IIEF-5）评估男性勃起功能。

结果

与对照组相比，实验组患者手术时间增加[（146±24）min vs （125±28） min，P<0.01]。实验组术后RUV值[术后7 d：（32±16） ml vs（52±19） ml，P=0.005；术后1个月：（26±13） ml vs （40±18） ml，P=0.026]及IPSS值[术后7 d：（8±4）分vs（12±5）分，P=0.008；术后1个月：（6±3）vs（8±4），P=0.021]均低于对照组。实验组术后IIEF-5数值高于对照组[术后3个月：（10.7±2.2） vs （9.3±2.4），P<0.01；术后6个月：（15.4±1.8）vs（13.2±2.0），P<0.01]。

结论

腹腔镜直肠癌根治术中使用神经电刺激技术辨识保护盆腔自主神经是可行的，能更有效保护患者术后的排尿及勃起功能。

关键词: 直肠癌, 腹腔镜, 神经电刺激技术, 排尿功能, 性功能
Objective

To study the effect of intra-operative electrical nerve stimulation on preservation of pelvic autonomic nerve during radical laparoscopic proctectomy, and investigate its effect on protection of urinary and sexual functions.

Method

Ninety two patients who underwent radical laparoscopic proctectomy between October 2014 and October 2016 in the Third Affiliated Hospital of Sun Yat-sen University were included prospectively. The experimental group underwent intra-operative electrical nerve stimulation on pelvic autonomic nerve during operation. In contrast, the pelvic autonomic nerve of the control group was assessed visually. Urinary function was evaluated by residual urine volume (RUV), international prostatic symptom score (IPSS) and recatheterization rate. Male erectile function was evaluated using the international index of erectile function (IIEF-5) scale.

Results

Compared with the control group, the experimental group required more operative time [(146±24) min vs (125±28) min, P<0.01], and less deterioration in postoperative RUV [7 days:(32±16) ml vs (52±19) ml, P=0.005]; 1 month: [(26±13) ml vs (40±18) ml, P=0.026], lower IPSS [(7 days: (8±4) vs (12±5), P=0.008; 1 month: (6±3) vs (8±4), P=0.021] and higher IIEF score[3 months: (10.7±2.2) vs (9.3±2.4), P<0.01; 6 months: (15.4±1.8) vs (13.2±2.0), P<0.001].

Conclusion

Intra-operative electrical nerve stimulation is feasible for assessment of pelvic autonomic nerve during radical laparoscopic proctectomy. It is more effective in protection of urinary and male erectile functions.

Key words: Rectal cancer, Laparoscopy, Electrical nerve stimulation, Urinary function, Sexual function
图3 腹腔镜PANP术中神经电刺激技术辨识盆丛
表1 两组患者术前临床资料比较
组别 例数 年龄（岁，±s） 性别（例） BMI（kg/m2，±s） 新辅助化疗（例） 肿瘤部位（例）
男 女 高位（8～12 cm） 中低位（<8 cm）
实验组 48 59±6 36 12 21.1±3.2 10 36 12
对照组 44 60±6 31 13 20.5±4.8 8 34 10
统计值 ? t=0.910 χ2=0.240 t=1.482 χ2=0.103 χ2=0.065
P值 ? 0.382 0.624 0.102 0.749 0.799
组别 肿瘤大小[cm2，M（Q）] 手术类型 TNM分期 手术时间（min，±s） 出血量（ml，±s）
LAR（例） APE（例） Ⅰ期（例） Ⅱ期（例） Ⅲ期（例）
实验组 9(12.00) 42 6 17 23 8 146±24 30(30.00)
对照组 12(9.75) 40 4 18 20 6 125±28 50(51.25)
统计值 χ2=-1.096 χ2=0.275 χ2=0.715 t=-3.900 χ2=-1.319
P值 0.273 0.600 0.398 <0.001 0.187
表2 两组患者术前、术后排尿功能比较
分组 RUV（ml，±s） 排尿功能障碍[例（%）] IPSS（分，±s） 二次导尿率[例（%）]
术前 术后7 d 术后1个月 术前 术后7 d 术后1个月 术后6个月
实验组 13±7 32±16 26±13 2（4.2%） 2.6±0.3 7.7±4.2 6.1±3.2 5.1±2.1 2（4.2）
对照组 14±7 52±19 40±18 05（11.4%） 2.8±0.4 11.6±5.4 7.8±3.5 5.6±2.2 4（9.1）
统计值 t=0.174 t=5.608 t=4.343 χ2=1.691 t=1.241 t=3.851 t=2.438 t=1.721 χ2=0.913
P值 0.738 0.005 0.026 0.253 0.334 0.008 0.021 0.076 0.421
表3 两组男性患者勃起功能（IIEF-5评分，±s）
分组 例数 术前 术后3个月 术后6个月
实验组 48 20.6±1.3 10.7±2.2 15.4±1.9
对照组 44 20.8±1.4 9.3±2.4 13.2±2.0
P值 ? 0.934 <0.001 <0.001
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