Objectives:To observe the effect of laparoscopic and open radical pelvic autonomic nerve pres-ervation colorectal cancer surgery on the urinary function and male sexual function of elderly patients.Methods:A total of 90 elderly male patients with colorectal cancer in our hospital from January 2010 to June 2013 were selected, and divided according to the different surgeries,39 cases using open surgery and 51 cases using laparoscopic surger-y.Patients in both groups received Mesangial full rectal excision surgery and pelvic autonomic nerve preservation (TME +PANP).The postoperative catheter removal time,urine output of after 2 weeks and after three months, maximum flow rate,residual urine volume,and the erection and ejaculation function of two groups of patients,be-fore and 3 months after operation were recorded and comparatively analyzed.Results:For patients in the open sur-gery group,the incidence of voiding dysfunction two weeks after was higher than that in the laparoscopic surgery group,with statistically significant difference (open surgery group of 30.7%,laparoscopic surgery group of 9.8%;t =8.69,P =0.015).The differences between the two groups in terms of urine output after two weeks was of no statistical significance (open surgery group of 326 ±33.1mL,laparoscopic surgery group of 323 ±32.9mL;t =1.31,P =0.814).The catheter pull out of time,maximum flow rate,residual urine of the laparoscopic group were 2.6 ±0.8d,29.8 ±3.2mL/s,and 15.8 ±3.6mL respectively,better than the open surgery group,which were 5.1 ±0.9d,22.2 ±3.1mL/s and 23.1 ±3.8mL.The difference was statistically significant (catheter pull out of time:t =8.69,P =0.015;maximum flow rate:t =5.67,P =0.042;residual urine:t =5.93,P =0.038).3 months after surgery,the incidence of voiding dysfunction,urine output,maximum flow rate and residual urine of the lapa-roscopic group were 5.9%,324 ±32.6mL,29.0 ±3.2mL/s and 16.1 ±3.3mL,better than the open surgery group of 5.1%,321 ±32.2mL,26.2 ±3.4mL/s and 18.5 ±3.7mL,without statistically significant difference(u-rination disorders:t =2.41,P =0.726;urine output:t =1.56,P =0.792;maximum flow rate:t =3.31,P =0.241;residual urine:t =3.72,P =0.151).3 months after surgery,the incidence of erectile dysfunction and e-jaculatory dysfunction in the laparoscopic group were 11.7% and 13.7%,lower than the laparotomy group (35.9%,38.5%).The difference was statistically significant (erectile dysfunction rate:t =8.15,P =0.019;e-jaculatory dysfunction rate:t =7.54,P =0.023).Conclusion:Pelvic autonomic nerve preservation radical surgery may be better to save the urinary function and sexual function of colorectal cancer patients.With less invasive, quick recovery and relatively minor nerve damage,laparoscopic operation is worthy of clinical application,besides its superior postoperative recovery urination and sexual function to open surgery.%目的：观察腹腔镜与开腹保留盆腔自主神经直肠癌根治术对老年男性患者排尿功能和性功能的影响。方法：选择2010年1月至2013年6月治疗的直肠癌老年男性患者共90例，依据手术方式分为腹腔镜手术组（51例）和开腹手术组（39例），两组患者均行全直肠系膜切除术及保留盆腔自主神经（TME ＋PANP）。而后对两组患者的术后拔除尿管时间，术后2周和术后3个月的排尿量、最大尿流率、残余尿量以及两组患者术前和术后3个月的勃起和射精功能进行记录并对比分析。结果：术后2周开腹组的排尿障碍发生率是30.7％，腹腔镜组是9.8％，两组差异具有统计学意义（t ＝8.690，P ＝0.015）；两组患者在术后2周的排尿量方面，腹腔镜组（326±33.1）mL、开腹组（323±32.9）mL，差异无统计学意义（t ＝1.310，P ＝0.814），而腹腔镜组尿管拔出时间是（2.6±0.8）d、最大尿流率是（29.8±3.2）mL／s、、残余尿是（15.8±3.6） mL，明显优于开腹组的（5.1±0.9）d、（22.2±3.1）mL／s、（23.1±3.8）mL，两组患者在这3方面的差异具有统计学意义（尿管拔出时间：t ＝8.690，P ＝0.015；最大尿流率：t ＝5.670，P ＝0.042；残余尿：t ＝5.930，P ＝0.038）；在手术3个月后的排尿功能障碍发生率、排尿量、最大尿流率、残余尿量方面腹腔镜组分别为：5.9％、（324±32.6）mL、（29.0±3.2）mL／s、（16.1±3.3）mL；而开腹组分别为：5.1％、（321±32.2）mL、（26.2±3.4）mL／s、（18.5±3.7）mL，两组的差异无统计学意义（排尿障碍率：t ＝2.410，P ＝0.726；排尿量：t＝1.560，P ＝0.792；最大尿流率：t ＝3.310，P ＝0.241；残余尿：t ＝3.720，P ＝0.151）；腹腔镜组患者在术后3个月的勃起功能和射精功能障碍发生率分别为11.7％、13.7％，均低于开腹组的35.9％、38.5％，差异具有统计学意义（勃起障碍率：t ＝8.150，P ＝0.019；射精障碍率：t ＝7.540，P ＝0.023）。结论：直肠癌患者行根治术时保留盆腔自主神经可较好保存患者的排尿功能和性功能，而采用腹腔镜操作创伤小、患者康复快、对神经的损伤较轻微，患者术后排尿和性功能的恢复要优于开腹手术，值得在临床工作中合理应用。
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