探讨腹腔镜全直肠系膜切除术(TME)中保留盆腔自主神经(PANP)对男性直肠癌患者排尿功能、性功能的影响及其应用效果。

回顾性选取2016年8月至2019年10月153例行TME+PANP的男性直肠癌患者，根据手术方式分为开腹组82例和腹腔镜组71例。观察两组患者术后排尿功能、性功能障碍率及术后1年局部复发情况，评价其疗效。采用统计软件SPSS 21.0进行数据分析处理，排尿功能计量资料用(±s)表示，采用独立样本t检验；性功能及复发率等计数资料采用χ²检验，排尿功能采用秩和检验；P<0.05表示差异有统计学意义。

术后3个月，腹腔镜组膀胱最大容量、最大尿流量、残尿量及排尿功能障碍率优于开腹组(P<0.05)；勃起功能障碍率和射精功能障碍率低于开腹组(P<0.05)。术后1年两组局部复发率(2.8% vs. 6.1%)组间差异无统计学意义(χ²＝0.938，P＝0.333)。

腹腔镜全直肠系膜切除术中保留盆腔自主神经能够有效改善男性患者术后排尿功能、性功能障碍，可在临床推广应用。

To investigate the effect of pelvic autonomic nerve preservation (PANP) in laparoscopic total mesorectal resection (TME) in terms of urinary function and sexual function of male patients with rectal cancer.

Clinical data of 153 male patients with rectal cancer treated with TME+ PANP from August 2016 to October 2019 were analyzed retrospectively. According to the surgical methods, 82 patients were divided into the open group and 71 cases into the laparoscopic group. The postoperative urination function, sexual function, dysfunction rate and local recurrence in both groups were observed, and the efficacy was evaluated. Statistical analysis were performed by using SPSS 21.0 software. The measurement data of urination function were expressed as(±s), and were examined by using independent t test. Count data such as sexual function and recurrence rate were analyzed by using χ² test, and the urination function was analyzed by using rank sum test. A P value of <0.05 was considered as statistically significant difference.

Three months after the operation, the maximum bladder volume, maximum urine flow, residual urine volume and the rate of urinary dysfunction in the laparoscopic group were much better than those in the open group respectively (P<0.05); The rates of erectile dysfunction and ejaculation dysfunction were much lower than those of the open group respectively (P<0.05). One year after surgery, there was no significant difference between the two groups in local recurrence rate of (2.8% vs. 6.1%, P>0.05).

Pelvic autonomic nerve preservation during laparoscopic total mesorectal resection could effectively improve postoperative urination function and sexual dysfunction of male patients, which would be popular in clinical application.