直肠术后低位前切除综合征高危因素分析  

Risk factors for low anterior resection syndrome

作　　者：吴国举[1] 贾文焯[1] 安琦[1] 余涛[1] 曹祥龙[1] 肖刚[1] Wu Guoju, Jia Wenzhuo, An Qi, Yu Tao, Cao Xianglong, Xiao Gang.(Department of Gastrointestinal Surgery, Beifing Hospital, National Center of Gerontology, Beijing 100730, Chin)

机构地区：[1]北京医院胃肠外科,100730

出　　处：《中华医学杂志》2018年第12期917-920,共4页National Medical Journal of China

摘　　要：目的直肠低位前切除术在保留肛门括约肌的同时可能造成术后一系列肠道功能障碍，即低位前切除综合征（LARS）。本研究旨在分析确定直肠低位前切除术后肠功能障碍的发生率和危险因素。方法回顾性分析了2010年1月至2015年12月在北京医院胃肠外科收治的直肠癌患者临床病理资料。在随访过程中采用LARS问卷对研究对象的排便功能进行评估。比较严重LARS和轻度／无LARS组的临床因素之间的差异。结果共有254例完成量表评分并最终纳入本研究。112例患者（44．1％）出现了严重的LARS症状。新辅助放化疗（OR=2．814，95％CI：1．097～5．561，P〈0．001），低位肿瘤（OR=3．568，95％CI：1．159—6．546，P〈0．001）以及吻合口漏（OR=6．574，95％CI：1．689～15．367，P〈0．001）是LARS的独立危险因素。结论直肠低位前切除术后的排便功能障碍具有较高的发生率和严重程度。对于具有LARS危险因素的患者，外科医生应充分告知风险，选择合理的病例进行保肛手术，避免严重LARS对患者生活质量造成的损害。Objective While low anterior resection avoided a permanent stoma, it might also cause bowel dysfunction which can significantly impact patients＇ quality of life. The objective of this study was to identify the incidence and risk factors for the development of bowel dysfunction following rectal surgery. Methods Patients undergoing anterior resection for rectal neoplasm between January 2010 and December 2015 were identified from a rectal cancer database at the Department of Gastrointestinal Surgery, Beijing Hospital. All patients were asked to fill in a low anterior resection syndrome （LARS） questionnaire. Clinical factors were compared between patients with major LARS and those with minor or no LARS using conditional logistic regression. Results There was 254 patients enrolled in the study. One hundred and eleven （44. 1% ） had major LARS symptoms. Neoadjuvant radiotherapy （ OR = 2. 814, 95% CI： 1. 097 - 5. 561, P 〈 0. 001 ） , low tumor location （ OR = 3. 568, 95% CI： 1. 159 - 6. 546, P 〈 0. 001 ） and anastomotic leakage （ OR = 6. 574, 95% CI： 1. 689 - 15. 367, P 〈 0. 001 ） were independent risk factors for development of major LARS symptoms. Conclusions For patients with high risk of low anterior resection syndrome, the potential for long-term poor functional results should be discussed with patients and form a part of the decision-making in individual treatment plans. Sphincter-preserving surgery should be performed in highly selected patients to avoid major bowel dysfunction.

关 键 词：低位前切除综合征 排便功能障碍 直肠肿瘤 

分 类 号：R735.37[医药卫生—肿瘤]