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남성 직장암 환자에서 전직장간막 절제술 및 골반자율신경 보존술 후 배뇨 및 성기능에 대한 평가

Assessment of Sexual and Voiding Function after Total Mesorectal Excision with Pelvic Autonomic Nerve Preservation in Male Rectal Cancer Patients

대한대장항문학회지 2002년 18권 5호 p.287 ~ 293
김남규 ( Kim Nam-Kyu ) - 연세대학교 의과대학 외과학교실

안태완 ( Ahn Tae-Wan ) - 연세대학교 의과대학 제생병원
박재균 ( Park Jea-Kun ) - 연세대학교 의과대학 외과학교실
이강영 ( Rhee Kang-Young ) - 연세대학교 의과대학 외과학교실
이웅희 ( Lee Woong-Hee ) - 연세대학교 의과대학 비뇨기과학교실
손승국 ( Sohn Seung-Kook ) - 연세대학교 의과대학 외과학교실
민진식 ( Min Jin-Sik ) - 연세대학교 의과대학 외과학교실

Abstract


Purpose: The aim of this study was to assess the safety of TME with pelvic autonomic nerve preservation in male rectal cancer patients in terms of voiding and sexual function.

Methods: We performed uroflowmetry using Urodyn (Dantec, Denmark) and a standard questionnaire employing the IIEF (International Index of Erectile Function) and the IPSS (International Prostate Symptom Score) pre- and postoperatively in 68 male rectal cancer patients.

Results: There were significant differences of mean maximal flow rate and voided volume before and after surgery (18.9±5.7 vs 13.7±7.0, 240±91.9 vs 143±78, P<0.05, P<0.05), respectively. But, there was no difference of residual volume before and after surgery (4.4±2.6 vs 8.1±4.4, P>0.05). The total IPSS (International Prostate Symptom Score) was increased after surgery from 6.2±5.8 to 9.8±5.9 (P<0.05). There were no changes of score for one of each seven IPSS items in from 49 patients (73.5 percent) to 61 patients (89.7 percent). Five IIEF (International Index of Erectile Function) domain score (erectile function, intercourse satisfaction, orgasmic function, sexual desire and overall satisfaction) was statistically decreased after surgery (18.2±9.3 vs 13.5±9.0, 8.4±4.2 vs. 4.4±2.9, 5.8±2.9, vs. 4.4±2.9, 6.1±2.4 vs. 4.8±2.0, 6.1±2.2 vs. 4.5±2.3, P<0.05, respectively. Erection was possible in 55 patients (80.9 percent), but penetration ability was possible in 51 patients (75 percent). Complete inability for erection and intercourse was observed in 3 patients (5.5 percent). Retrograde ejaculation was noted in 9 patients (13.2 percent). IIEF domains such as sexual desire and overall satisfaction were markedly decreased in 39 patients (57.4 percent), 43 patients (63.2 percent), espectively. Multiple regression analysis of factors affecting postoperative sexual dysfunction showed that over 60 years (sexual desire: P=0.019), within 6 months (erectile function: P=0.04, intercourse satisfaction: P=0.011, orgasmic function: P=0.03), lower rectal cancer (erectile function: P=0.02, intercourse satisfaction: P=0.036, orgasmic function: P=0.027) were significant factors.

Conclusions: TME with pelvic autonomic nerve preservation technique showed a safety and comparable data in preserving sexual and voiding function. The IPSS and IIEF questionnaire were useful and more investigative in assessing urinary and sexual function.

키워드

직장암;전직장간막 절제술;골반자율신경 보존술;배뇨 및 성기능
Rectal cancer;Total mesorectal excision with pelvic autonomic nerve preservation;urinary and voiding function;IPSS;IIEF
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