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目的:评估骶骨肿瘤手术不同水平的骶神经根切除后对男性勃起及射精功能的影响,探讨骶神经根损伤水平与勃起及射精功能障碍的关系。方法:回顾性研究2008年1月至2013年8月47例接受骶骨肿瘤手术的患者术前及术后阴茎勃起及射精功能情况。按保留骶神经水平分:保留双侧S1~S3患者16例,保留单侧S1~S3患者21例,保留单侧S1~S2患者6例,仅保留单侧S1患者4例。随访时间12~41(27.2±10.9)个月。通过发放调查表、门诊复查及电话随访患者术后3个月、6个月、1年及至2013年8月的阴茎勃起及射精功能情况。结果:保留双侧S1~S3神经根患者,术后3个月阴茎勃起及射精功能障碍发生率为31.25%(5/16),术后6个月为25.00%(4/16),术后1年为12.50%(2/16),2013年8月随访时阴茎勃起及射精功能均恢复。保留单侧S1~S3神经根患者,术后3个月阴茎勃起及射精功能障碍发生率为85.7%(18/21)。术后6个月为71.43%(15/21),术后1年为52.38%(11/21)。2013年8月随访时阴茎勃起及射精功能障碍发生率为42.86%(9/21)。保留单侧S1~S2神经根患者,术后3个月阴茎勃起及射精功能障碍发生率为100%(6/6)。术后6个月和术后1年均为83.33%(5/6),2013年8月随访时阴茎勃起及射精功能障碍发生率为66.67%(4/6)。仅保留单侧S1神经根患者,术后3个月至2013年8月随访时阴茎勃起及射精功能均不能恢复。对不同年龄、肿瘤类型的患者阴茎勃起及射精功能障碍发生率进行比较,差异无显著性(P均>0.05)。结论:男性患者骶骨肿瘤术后阴茎勃起及射精功能障碍发生率与手术方式密切相关。至少保留一侧的S3神经根对患者术后阴茎勃起及射精功能的保存是至关重要的。
Objective: To evaluate the erectile function and ejaculation function of sacral tumor after sacral root excision at different levels of sacral tumor surgery, and to explore the relationship between sacral nerve root injury and erectile dysfunction. Methods: The erectile function and ejaculation of preoperative and postoperative erectile function in 47 patients who underwent sacral tumor surgery from January 2008 to August 2013 were retrospectively studied. According to the reserved sacral nerve level, 16 patients with bilateral S1 ~ S3, 21 patients with unilateral S1 ~ S3, 6 patients with unilateral S1 ~ S2, 4 patients with unilateral S1 were reserved. The follow-up time ranged from 12 to 41 (27.2 ± 10.9) months. Through the issuance of the questionnaire, outpatient review and telephone follow-up of patients with penile erection and ejaculation function after 3 months, 6 months, 1 year and up to August 2013. Results: The incidence of erectile dysfunction and ejaculation dysfunction was 31.25% (5/16) at 3 months and 25.00% (4/16) at 6 months after operation in both S1 ~ S3 nerve roots. One year was 12.5% (2/16). At the follow-up in August 2013, the penile erection and ejaculation function recovered. The patients with unilateral S1 ~ S3 nerve root were preserved. The incidence of penile erection and ejaculation dysfunction was 85.7% (18/21) at 3 months after operation. 71.43% (15/21) at 6 months and 52.38% (11/21) at 1 year after operation. The incidence of erectile dysfunction and ejaculation dysfunction at follow-up in August 2013 was 42.86% (9/21). Patients with unilateral S1 ~ S2 nerve root were preserved. Penile erection and ejaculation dysfunction occurred at 3 months after operation. The incidence of ejaculation dysfunction was 100% (6/6). The incidence of erectile dysfunction and ejaculation dysfunction was 66.67% (4/6) at 6 months and one year after operation, respectively, which was 83.33% (5/6) at follow-up in August 2013. Only patients with unilateral S1 nerve root were preserved, and penile erection and ejaculation function were not recovered after 3 months to August 2013 follow-up. The incidence of erectile dysfunction and ejaculation dysfunction in patients of different ages and tumor types were not significantly different (all P> 0.05). Conclusion: The incidence of erectile dysfunction and ejaculation dysfunction after sacral tumor in male patients is closely related to the surgical method. Retaining at least one side of the S3 nerve root is essential for preserving penile erections and ejaculation in patients.