Effect Of L-PANP+TME On Postoperative Urinary And Sexual Function In Male Patients

Objective: This article aims to compare pelvic autonomic anatomy for laparoscopic pelvic autonomic nerve preserving total mesorectal excision and laparoscopic total mesorectal excision of male patients after urination,sexual function of the protective effect,so as to Clinical surgical treatment to provide the basis for seeking more effective ways to improve postoperative quality of life of patients with low rectal cancer surgery.Methods: To collect the clinical data of 62 male rectal cancer patients who met the inclusion criteria from July 2015 to August 2017 in the gastrointestinal surgery department of the Affiliated Hospital of Youjiang Medical College for Nationalities,using a retrospective analysis to demarcate the time in August 2016.Patients undergoing laparoscopic total mesorectal excision(LS group,n=31)before August 2016,and patients undergoing laparoscopic pelvic autonomic nerve preservation with pelvic autonomic nerve as an anatomical landmark after August 2016 Mesenteric resection(L-PANP group,n=31).The time for removing the catheter was recorded in both groups.The residual urine volume was recorded at 3 and 6 months after operation.The International Prostate Symptom Scoring Scale(IPSS)and the International Erectile Function Scale(IIEF)were used.The “China Premature Ejaculation Patient Sexual Function Scale”(CIPE)assesses and compares the effects of the two surgical methods on postoperative urination and sexual function in men with low rectal cancer.Results: Of the 62 patients,3 in the L-PANP group and 5 in the LS group were excluded due to loss of follow-up and withdrawal.The actual cases were 54 cases,L-PANP group 28 cases,and LS group 26 cases.1.Effect of L-PANP+TME on postoperative voiding function in male patients The time of catheter removal in L-PANP group and LS group was 2.50±0.37 days and 4.02±0.65 days,respectively;the residual urinary bladder volume in patients in L-PANP group before surgery and 3 months and 6 months after operation was 7.43±2.96,respectively.In ml,13.36±5.22 ml,and 8.11±3.27 ml,the incidence of voiding dysfunction was 0.00%,32.14%,and 14.29%,respectively,and the IPSS scores were 0.00,2.46 ± 5.71,and 0.39 ± 1.23,respectively;The residual urinary bladder volume was 7.69±3.07 ml,22.54±9.46 ml,and15.88 ± 6.59 ml in 3 months and 6 months after operation respectively.The incidence of voiding dysfunction was 0.00%,61.54%,and 46.15%,respectively.The IPSS scores were0.00 points,5.62± 7.93 points,2.65 ± 3.91 points.There was no significant difference in residual urine volume and IPSS scores between the two groups before operation(P>0.05).Postoperative L-PANP patients had less time to remove the urethra than the LS group.Postoperative March and June L-PANP group The urinary function classification was better than the LS group,and the residual urine volume,the incidence of voiding dysfunction in the L-PANP group,and the IPSS score were all lower than in the LS group,and the difference was statistically significant(all P < 0.05).2.The effect of TME+PANP on postoperative sexual function in male patients2.1 Erectile function: In the L-PANP group,the prevalence of erectile dysfunction before and after 3 months and 6 months after operation were 0.00%,42.86%,and 25.00%,respectively,and the IIEF scores were 24.21±1.10,20.14±5.37,and 21.75,respectively.±4.49 points;the incidence of erectile dysfunction in the LS group was 0.00%,65.38%,50.00% before surgery,and 3 months and 6 months after operation.The IIEF scores were 24.19±1.02,15.69±7.55,and 18.50±5.59,respectively.Minute.There was no significant difference in IIEF scores between the two groups before operation(P>0.05).In the 3rd and 6th months after operation,the L-PANP group had better erectile function than the LS group,and the L-PANP group had a lower incidence of erectile dysfunction than the LS group.The total score of IPSSwas higher than that of LS group,and the difference was statistically significant(all P < 0.05).2.2 Ejaculatory function: In the L-PANP group,the preoperative and postoperative 3 and 6months incidences of ejaculatory dysfunction were 0.00%,46.43%,and 28.57%,respectively,and CIPE scores were 45.18±4.47,37.50±9.35,and 41.32,respectively.±5.79 points;The incidence of ejaculatory dysfunction before surgery,3 months and 6 months after operation in the LS group was 0.00%,69.23%,and 61.54%,respectively.CIPE scores were 44.58±4.83,26.81±11.68,and 34.04±9.76,respectively.Minute.There was no significant difference in preoperative CIPE scores between the two groups(P>0.05).Postoperative ejaculation functional grading was better in the L-PANP group than in the LS group,and the incidence of ejaculatory dysfunction was lower in the L-PANP group than in the LS group.The total score of CIPE was higher than that of LS group,and the difference was statistically significant(all P< 0.05).Conclusion: The use of pelvic autonomic nerve(PAN)as an anatomical landmark for laparoscopic radical resection of lower rectal cancer can reduce the damage to postoperative urinary function and sexual function of male patients while implementing the TME concept.