| Purpose: In this paper,we compare the effect of radical rectal cancer surgery with laparoscopic preservation of the pelvic autonomic nerve while preserving the left colonic artery and trophoblastic artery with laparoscopic rectal cancer surgery alone on the protection of pelvic organ function in men after rectal cancer surgery,and explores the impact of function-preservation-oriented rectal cancer surgery on patients’ postoperative quality of life,intending to provide a reference for reducing pelvic organ dysfunction after rectal cancer surgery.Methods: The clinical data of 134 male patients with low to moderate rectal cancer treated by laparoscopic radical rectal cancer in the Department of Gastrointestinal Surgery of the Affiliated Hospital of Yangzhou University from January 2016 to December 2021 were selected,and two different surgical approaches were used in chronological order.Seventy-two patients underwent laparoscopic TME with complete preservation of the pelvic autonomic nerve and simultaneous preservation of the left colonic artery and trophoblastic artery(observation group),and 62 patients underwent laparoscopic TME alone(control group).The clinical data collected included general information such as patients’ age,gender,BMI,tumor size,distance from the lower edge of the tumor to the anus,tumor TNM stage,ASA classification,etc.;intraoperative data included blood loss,number of intraoperative lymph node dissection,and operation time;postoperative recovery indicators included preoperative and postoperative albumin and hemoglobin values,postoperative hospitalization days,postoperative complications,postoperative first venting time,postoperative The postoperative recovery indicators included preoperative and postoperative albumin and hemoglobin values,postoperative hospitalization days,postoperative complications,postoperative first defecation time,postoperative first defecation time,and indwelling catheter time.Time of drainage tube removal after surgery,time of catheter removal after surgery.In addition,relevant functional indicators were followed up at six months and one year after discharge,including outpatient follow-up at postoperative review,postoperative radiotherapy inpatient follow-up,or follow-up by telephone,We Chat,questionnaire,etc.The followup included the International Prostate Symptom Scale and Quality of Life Index scale,the International Index of Erectile Dysfunction Self-Measurement Scale [1],and the Ejaculatory Function Rating Scale [2],and Low Anterior Resection Syndrome score [3],thus assessing and comparing postoperative pelvic organ function.Result:(1)Comparison of general data: there were no statistically significant differences between the observation group and the control group in available data such as age,BMI,ASA classification,tumor TNM stage,tumor size,distance of the lower edge of the tumor from the anal opening,and whether prophylactic stoma was performed(P>0.05).(2)Comparison of perioperative indicators: compared with the surgical conditions of the two groups,the operating time of the observation group was significantly longer than that of the control group,with statistical differences(P<0.001),but no significant differences were found in the intraoperative blood loss and the number of lymph nodes detected between the two groups(P>0.05).Comparing the postoperative recovery of the two groups,the time to defecate after surgery(4.61 ± 1.19 days vs.5.32 ± 1.14 days),the time to eat after surgery(4.69 ± 2.41 days vs.6.21 ± 2.23 days),and the time to remove the drainage tube after surgery(10.29 ± 1.90 days vs.11.48 ± 2.07 days)were shorter in the observation group than in the control group,and the recovery time of the above indexes in the observation group was The time required for recovery in the observation group was shorter than that in the control group,and the difference was significant(P<0.001).(3)Comparison of the occurrence of the anastomotic leak: 2 cases occurred in 72 patients in the observation group.In comparison,7 cases of anastomotic leak occurred in62 patients in the control group,with a higher incidence of anastomotic leak in the control group.Also,comparing the incidence of postoperative anastomotic bleeding in the two groups was 1.39% and 6.45%;again,the observation group was better than the control group,but the two were not statistically significant,and there was no significant difference.(4)Comparison of functional results: urinary function,the time to remove the urinary catheter after surgery was(3.76 ± 0.81 days vs.4.45 ± 1.04 days)for patients in the observation group and control group,respectively,and the time to leave the catheter after surgery was shorter in the observation group than in the control group,and the difference was significant(t=-4.303,P<0.001).When comparing the postoperative International Prostate Score between the two groups,the observation group and the control group were 6 months postoperative(9.26±1.87 vs.10.98±2.11)and 12 months postoperative(6.81±2.46 vs.8.37±1.36),respectively,and the observation group had better scores than the control group,with a significant difference(P<0.01),and in addition the two The postoperative quality of life index scores regarding voiding function were compared,and at 12 months postoperatively(1.39±1.00 vs.2.48±1.18),the observation group was better than the control group,and there was a statistically significant difference(P<0.01);sexual dysfunction was compared: the incidence of erectile dysfunction at 6months postoperatively in both groups(19.44% vs.40.32%)and the incidence of erectile dysfunction at 12 months postoperatively(12.5% vs.22.58%)were better in the observation group than in the control group,and all were statistically significant(P<0.05).The incidence of ejaculatory dysfunction at six months(16.67% vs.33.87%)and 12months(9.72% vs.24.19%)after surgery was also better in the observation group than in the control group,and both were statistically significant(P<0.05);the LARS scores at 6and 12 months after surgery were better in the observation group than in the control group.In comparison,the LARS scores at 6 and 12 months after surgery were better in the observation group than in the control group,and the difference was significant(P<0.01),and the rate of severe fecal dysfunction at six months after surgery was significantly lower in the observation group than in the control group(15.3% vs.40.3).Conciusions:(1)Laparoscopic radical surgery for rectal cancer oriented to preservation of function is safe and feasible,and is conducive to better preservation of postoperative urinary and sexual functions,in addition to improving the defecation dysfunction that occurs after surgery.(2)Preserving the pelvic autonomic nerve while preserving the left colonic artery and trophoblastic artery is advantageous for reducing postoperative pelvic organ dysfunction,decreasing the incidence of postoperative anastomotic leakage,and improving postoperative quality of life in rectal cancer,which is worth promoting in clinical practice,and we look forward to the observation of further long-term functional preservation effects... |
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