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Effect of Pelvic Autonomic Nerve Preservation on Sexual Function in Patients Undergoing Laparoscopic Total Mesorectal Excision of Rectal Cancer

目的　探討腹腔鏡全直腸系膜切除術盆腔自主神經保留的可行性及對術后性功能的影響。方法　對我院2004年2月至2006年5月期間21例中低位直腸癌患者施行腹腔鏡全直腸系膜切除保留盆腔自主神經手術，調查了解患者術后性功能情況。結果　21例患者性功能均存在,絕大多數(18例)患者勃起功能良好。結論　腹腔鏡下全直腸系膜切除術保留盆腔自主神經是可行的，患者性功能恢復滿意。

Study on the Clinical Effect of Biofeedback Therapy for Functional Constipation

摘要:目的: 隨機對照研究、評估生物反饋訓練治療慢性功能性便秘的療效。 方法 : 60例慢性功能性便秘患者,隨機分為治療組30例和對照組30例。治療組接受1個療程(5周)生物反饋訓練治療(10次為一個療程、一次30～45分鐘、每周2次)。對照組患者接受聚乙二醇4000 10g BID 口服,療程5周。治療前后作便秘癥狀評分、結腸通過試驗檢測、直腸肛門壓力檢測。 結果 : 生物反饋訓練和聚乙二醇4000均可使多數慢性功能性便秘患者的大便次數、大便性狀及伴隨癥狀恢復正常或緩解,總有效率分別為667%和80%(P ＞005)。生物反饋訓練和聚乙二醇4000口服治療后,結腸通過試驗72小時標志物排出率分別為75%及73%,均較治療前明顯增加。生物反饋訓練治療后力排時肛門壓明顯下降。 結論 : 生物反饋訓練對出口梗阻型、慢傳輸型便秘均有效,是一種有效的、新興的治療慢性功能性便秘的方法,可作為功能性便秘的一線治療方法。Abstract: Objective: To assess the clinic effect of biofeedback therapy for functional constipation. Methods : Sixty cases of chronic functional constipation were randomly divided into treatment group (30 cases) and control group (30 cases). Cases in the treatment group were exposed to biofeedback for a fiveweeklong treatment course—individual treatment lasted for 3045 minutes and twice per week. Patients in the control group received PEG 4000 10g BID for five weeks. Data from constipation symptom score, colonic transit test, and anorectal manometry were done and compared before and after two kinds of treatments. Results : Biofeedback training and PEG 4000 could restore the stoolfrequency, stool characteristics and accompanying symptoms to normal or mitigation of the majority of patients with chronic functional constipation, with the total effective rates being 667% and 80% (P gt;005), respectively. After biofeedback training and PGE 4000 treatment, the discharge rate of 72hour markers of colonic transit test significantly increased to 75% and 73%, respectively. Additionally, anorectal pressure decreased dramatically after biofeedback training. Conclusion : Biofeedback training would play a positive role in outlet obstruction and slow transit constipation. Thus, it could be an effective firstline treatment of chronic functional constipation.

Effect of Pelvic Autonomic Nerve Preservation with Total Mesorectal Excision on Sexual and Urinary Function in Male Rectal Cancer Patients

ObjectiveTo investigate the effect of pelvic autonomic nerve preservation (PANP) with total mesorectal excision (TME) on sexual and urinary function in male rectal cancer patients. MethodsClinical data of eightyfour patients with rectal cancer from January 2008 to October 2010 in our hospital were analyzed. According to different operative techniques, all the patients were divided into two groups: PANP+TME group (n=41) and TME group (n=43). The sexual dysfunction, urination disorder rate, and local recurrence rate after operation of patients between two groups were compared. ResultsErectile dysfunction rate of patients in TME+PANP group and TME group was 29.3% (12/41) and 76.7% (33/43), ejaculation disorder rate was 26.8% (11/41) and 79.1% (34/43), and urination dysfunction rate was 24.4% (10/41) and 79.1% (34/43), respectively. The rate of sexual and urinary dysfunction of patients in TME+PANP group was significantly lower than that in TME group (Plt;0.05). Local recurrence rate of patients in TME+PANP group (9.8%, 4/41) was similar to that in TME group (11.6%, 5/43)， Pgt;0.05. ConclusionPANP based on TME can reduce effectively the rate of sexual and urinary dysfunction in male rectal cancer patients, which does not increase the local recurrence rate after operation.

肝移植現狀與面臨的挑戰

進入21世紀以來，肝移植已經成為治療終末期肝臟疾病、急性暴發性肝功能衰竭的一種最有效的選擇。據美國UNOS報道，在過去10年中，全世界已實施26 040例肝移植； 在先進的移植中心，肝移植受者的1年和3年存活率分別達到90%和80%，5年存活率達65%～75%，兒童肝移植和親屬活體肝移植存活率更高，除了存活時間延長外，生活質量得到明顯改善，包括恢復工作和生育能力。國內近年來肝移植也得到快速發展，年移植數在千例左右，開展的單位不斷增加，存活率得到提高，在先進的單位，開展的項目和水平逐漸接近國際水平。

Association between 5α-reductase inhibitors and sexual dysfunction in subjects with benign prostatic hyperplasia: a meta-analysis

ObjectiveTo systematically review the association between 5α-reductase inhibitors (5ARIs) and risk of sexual dysfunction in subjects with benign prostatic hyperplasia (BPH).MethodsPubMed, Web of Science, The Cochrane Library, EMbase, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect studies on the association between 5ARIs and risk of sexual dysfunction in subjects with BPH from inception to October 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by using Stata 12.0 software.ResultsA total of 15 studies involving 17 774 subjects were included. The results of the meta-analysis showed that compared with the placebo group, 5ARIs could significantly increase risk of erectile dysfunction (RR=1.52, 95%CI 1.36 to 1.69, P<0.000 1), while decrease libido (RR=1.79, 95%CI 1.37 to 2.32, P<0.000 1) and ejaculation disorder (RR=2.97, 95%CI 1.82 to 4.83, P<0.000 1) in subjects with BPH. Subgroup analysis of the type of 5ARIs, intervention period, publication year and sample size showed that the 5ARIs had a higher risk of sexual dysfunction than the placebo group.ConclusionsCurrent evidence shows that 5ARIs can increase risk of erectile dysfunction, decrease libido and ejaculation disorder in subjects with BPH. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.

降壓藥對老年高血壓患者動脈彈性功能的影響

老年原發性高血壓患者中，單純收縮期高血壓更常見，是心血管疾病的重要危險因素，主要歸因于彈性動脈僵硬度增加。年齡和血壓水平是影響動脈彈性功能的重要因素，而大動脈彈性功能減退是高血壓患者并發心腦血管意外的重要病理生理基礎，動脈壁結構和功能的改變是高血壓疾病發生發展的早期標志。盡管不同種類降壓藥物在降壓水平上總體差別很小，但對大動脈順應性的改變有所不同。

癲癇所致生殖內分泌功能障礙的研究進展

癲癇是腦部神經元過度異常放電導致的臨床綜合征，生殖內分泌功能紊亂是癲癇患者的常見疾病，對患者婚姻生育造成不良影響，目前尚未見到癲癇誘發患者生殖內分泌功能紊亂病因的總結報道。癲癇導致的神經內分泌功能障礙、抗癲癇藥物引起的不良反應以及癲癇共患病的不良影響皆可導致患者生殖內分泌功能紊亂。本綜述對目前已有的關于上述影響因素的研究結論進行總結，并提出了對預防癲癇所致的生殖內分泌功能紊亂的見解。

乳腺癌術后的性功能障礙

Preliminary study in the influencing factors of reproductive function in male patient with epilepsy

ObjectiveTo analyse baseline information, semen, sex hormones and sexual function to understand the differences between male patient with epilepsy(MPWE) and healthy men. At the same time, we preliminarily evaluated the risk factors related to reproductive function in MPWE to provide clinical method for reducing the risk of infertility.MethodsWe collected data of 112 MPWE in the Department of Neurology, First Affiliated Hospital of Dali University from February 2019 to February 2020. Sixty-seven healthy male volunteers matching the age of the survey group were selected. All men completed semen and sex hormone test. Men with sexual life experience completed the International index of erectile function scale (IIEF-5) and the Premature ejaculation diagnostic tool (PEDT). MPWE completed the Quality of life in epilepsy-1(QOLIE-31). The baseline data, semen quality, sex hormone level and sexual function questionnaire scores of MPWE and healthy controls were compared. In addition, according to the diagnostic criteria of abnormal male reproductive function, MPWE were divided into abnormal group and normal group. Single factor analysis and binary logistic regression analysis were used to preliminarily explore the related risk factors of reproductive function in MPWE.ResultsCompared with the healthy control group, the proportion of married and childbearing, testosterone level, sperm concentration, sperm survival rate and IIEF-5 score in MPWE were significantly reduced (P<0.05). Compared with the normal group, age, body mass index, seizure frequency and drug type in the abnormal group were significant differences statistically (P<0.05). The total score and energy score of QOLIE-31 in the abnormal group were significantly lower than that in the normal group (P<0.05). Binary Logistic regression analysis indicated that energy score [B=?0.033, OR=0.967, 95%CI(0.937, 0.999)], age [B=0.879, OR=2.408, 95%CI (1.070, 5.416)], seizure frequency [B=1.788, OR=5.976, 95% CI (2.031, 17.589)].ConclusionThe reproductive function of MPWE is lower than that in healthy men. The total score, energy score, age, body mass index, seizure frequency and type of drugs will significantly affect the reproductive function of MPWE. Energy score, age and seizure frequency are independent risk factors that affect the reproductive function of MPWE. Abnormal reproductive function of MPWE was positively correlated with age and seizure frequency, but negatively correlated with energy score.

Effect of Bariatric Surgery on Male’s Erectile Function: A Meta-analysis

Objective To systematically review the effect of bariatric surgery for male’s erectile function. Methods We electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 5, 2016), CNKI, VIP and WanFang Data from inception to May 30th 2016, to collect randomized controlled trials and before-after studies about bariatric surgery therapies for erectile function in obese male. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies. Then RevMan 5.3 software was used for meta-analysis. Results A total of 7 before-after studies involving 270 patients were included. The results of meta-analysis showed that: compared with before treatment, bariatric surgery could significantly improve 1-year erectile function score (MD=5.05, 95%CI 3.52 to 6.59, P < 0.000?01), 1-year sexual desire score (MD=0.99, 95%CI 0.47 to 1.51, P=0.000?2), 1-year contact satisfaction score (MD=2.70, 95%CI 0.21 to 5.19, P=0.004) and 1-year total satisfaction score (MD=1.68, 95%CI 0.27 to 3.09, P=0.002), but there was no significant difference in orgasm function score (MD= –0.21, 95%CI –0.74 to 0.33, P=0.45) between before and after treatment. Conclusion Bariatric surgery is effective in improving the erectile function, sexual desire and sexual satisfaction in morbidly obese male. Due to the limited quality and quantity of the included studies, the above conclusion needs to be verified by more large-scale high-quality studies.