The Impaction To Urinary Function Of Pelvic Autonomic Nerve Preservation Inradcalrescection

Objective:To explore the application for protecting urinary function of patients with pelvic autonomic nerve preservation in radical resection, and discuss the reasonablility and feasiblity, compared with non-pelvic autonomic nerve preservation surgery.Methods:Retrospective analysis 40 cases of advanced cancer patients of Provincial Hospital affiliated Shandong University from January to December in 2009,which composed by 20 patients with pelvic autonomic nerve preservation (TME+PANP) and 20 patients received non-radical surgery pelvic autonomic nerve preservation (TME) (two groups in age, disease location, Dukes stage, surgical procedure and operative time are matched). Demo the whole process of pelvic autonomic nerve preservation, the main nerves are retained:the hypogastric plexus, hypogastric nerve, pelvic plexus, pelvic splanchnic nerves. Analysis patients' urodynamic indicators within the experimental group and control group to assess the impection on urinary function.Results:The mean maximum urine flow urodynamics (mean maximal flow rate Qmax (ml/s)), experimental group patients (TME+ANP) Preoperative 18.9±5.7, postoperative 13.7±7, control group (TME) Qmax (ml/s) Preoperative 18.7±6.1, postoperative 11.5±6.3; P<0.05. The maximum flow rate of urinary pressure(cmH2O) experimental group patients (TME+ANP) Preoperative 35.7±20.8, postoperative 33.0±16.6, control group (TME) Preoperative 35.3±19.7, postoperative 25.8±16.5; P<0.05Detrusor systolic blood pressure (cmH2O) experimental group patients (TME+ANP) Preoperative 26.7±14.2, postoperative 23.7±12.4, control group (TME) Preoperative 25.7±14.2, postoperative 18.6±13.4; P<0.05.The average residual bladder volume (mean voided volume Vcomp (ml)), experimental group patients (TME+ANP) preoperative 365±32, after 346±46; the control group (TME) Vcomp (ml) preoperative353±39, after298±42; p<0.05. The average residual urine volume (mean residual volume RV (ml)), experimental group patients (TME+ANP) Preoperative 4.4±5.6, postoperative 8.1±11.4, control group (TME) RV (ml) preoperative 4.8±6.1, after 12.2±11.9; P> 0.05. Both the control group or the experimental group were significantly lower than postoperative sexual function before surgery, whereas the control group was lower than the experimental group.Conclusion:Compared with non-pelvic autonomic nerve surgery, patients'urinary function with advanced rectal cancer can be well preserved by pelvic autonomic nerve preservation, and the quality of life are greatly improved.