老年直肠癌保肛术后低位前切除综合征高危因素分析  

The Risk Factor Analysis on Low Anterior Resection Syndrome after Anus-preserving Surgery for Elderly Rectal Cancer

作　　者：景岚[1] 顾兴伟[2] 朱小艳[1] JING Lan;GU Xing-wei;ZHU Xiao-yan(Department of Anorectal Surgery,People's Hospital of Danyang,Danyang 212300,Jiangsu,China;Department of General Surgery,People's Hospital of Danyang,Danyang 212300,Jiangsu,China)

机构地区：[1]江苏省丹阳市人民医院肛肠科,丹阳212300 [2]江苏省丹阳市人民医院普外科,丹阳212300

出　　处：《中国现代手术学杂志》2019年第6期415-418,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨老年直肠癌保肛术后发生低位前切除综合征(low anterior resection syndrome,LARS)的高危因素。方法回顾性分析我院2012年1月~2018年12月间收治的100例老年直肠癌患者的临床资料。患者平均年龄(70.92±4.51)岁,均行直肠癌保肛根治术。术后随访3~12个月,观察术后LARS的发生情况,并对其影响因素进行单因素及多因素分析。结果本组术后发生LARS 36例,发生率为36.0%。其中,低位直肠癌23例,中高位直肠癌13例;合并基础疾病者10例;组织病理学:高分化11例,中分化13例,低分化12例;临床分期:A期2例,B期22例,C期12例;淋巴结转移8例;术前进行放疗8例;吻合口距肛缘≤5 cm者31例,>5 cm者5例;术后恢复时间≥6个月者18例。单因素分析显示,直肠癌术后LARS的发生与肿瘤位置(低位)、术前放疗及吻合口位置(距肛缘≤5 cm)有关(P<0.05),而与患者性别、组织病理学、是否合并基础疾病、临床分期、是否有淋巴结转移和术后恢复时间无关(P>0.05);多因素logistic回归分析显示,低位直肠癌、术前放疗及吻合口距肛缘≤5 cm是直肠癌术后LARS的独立危险因素。结论老年直肠癌保肛术后应针对其高危因素,采取针对性预防措施,降低LARS的发生率。Objective To investigate the high risk factors of low anterior resection syndrome(LARS)after anus-preserving surgery for elderly rectal cancer.Methods The clinical data of 100 elderly patients with rectal cancer who underwent radical anus preserving surgery admitted to our hospital from January 2012 to December 2018 were analyzed retrospectively,with the average age of(70.92±4.51)years old.The incidence of LARS was observed after 3 to 12 months follow-up,and the associated risk factors were analyzed by univariate analysis and multivariate analysis.Results LARS occurred in 36 cases,and the incidence was 36.0%.The univariate analysis revealed that the LARS after anus-preserving surgery was related to tumor location(low position),preoperative radiotherapy and anastomotic position(the distance from anal margin≤5 cm)(P<0.05),but was not related to gender,histopathology,combined basic disease,clinical stage,lymph node metastasis and postoperative recovery time(P>0.05).Multivariate logistic regression analysis showed that low rectal cancer,preoperative radiotherapy and anastomotic distance from the anal margin≤5 cm were the independent risk factors of LARS.Conclusion In order to reduce the incidence of LARS,the effective preventive measures should be taken for elderly rectal cancer patients according to the high risk factors.

关 键 词：直肠肿瘤 保肛术 低位前切除综合征 危险因素 

分 类 号：R735.37[医药卫生—肿瘤]