腹腔镜直肠癌保肛根治术后低位前切除综合征的发生及影响因素分析  

Occurrence and Influencing Factors of Low Anterior Resection Syndrome after Laparoscopic Anus Preserving Radical Resection of Rectal Cancer

作　　者：郭帆 韩斌[1] 黄琳凯 朱家佳 Guo Fan;Han Bin;Huang Linkai(Department of General Surgery,Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)

机构地区：[1]郑州大学第二附属医院普外科,郑州450014

出　　处：《华中科技大学学报（医学版）》2021年第2期194-200,共7页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：河南省科技厅重点攻关项目(No.122102310239)。

摘　　要：目的探究腹腔镜直肠癌保肛根治术后低位前切除综合征(LARS)的发生率及其影响因素。方法回顾性分析2018年1月~2018年12月于郑州大学第二附属医院普外科行腹腔镜直肠癌保肛根治术的患者临床资料,所有患者术中均遵循全直肠系膜切除(TME)原则,共有105例接受腹腔镜直肠癌保肛根治术患者完成量表评分最终纳入研究,其中男性56例,女性49例,年龄35~87岁,平均(64.5±7.5)岁;肿瘤TNM分期Ⅰ期23例,Ⅱ期11例,Ⅲ期71例。采用电话、微信、门诊、住院等方式随访记录患者术后3、6、12个月的排便情况;根据LARS评分评估研究对象的排便功能;通过LARS量表评分将研究对象分为LARS组(包括minor LARS及major LARS)和无LARS组(no LARS组),通过比较两组患者临床数据的差异,分析LARS的发生率及其影响因素。结果105例患者均成功完成腹腔镜下直肠癌保肛根治术,无中转开腹,手术时间为(257±10)min,术中出血量为(111.5±25.5)mL,术后拔除尿管时间为(32±4)h,术后首次排气时间为(6±1)d。105例患者术后3、6及12个月均完成LARS评分表。单因素分析显示:BMI(P=0.035)、吻合口距肛门距离(P<0.01)、肿瘤下缘距肛门距离(P=0.003)、术前放化疗(P=0.014)、术后吻合口漏(P=0.004)是影响患者术后3个月排便功能的相关因素,BMI(P=0.007;0.005)、吻合口距肛门距离(P=0.004;0.003)、术前放化疗(P=0.003;0.020)、术后吻合口漏(P<0.01;0.001)是影响患者术后6、12个月排便功能的相关因素。多因素分析显示:术前放化疗是影响患者术后3、6个月排便功能的独立危险因素(均P<0.05);BMI、吻合口距肛门距离、术后吻合口漏是影响患者术后3、6、12个月排便功能的独立危险因素(均P<0.05)。结论腹腔镜直肠癌保肛根治术后发生LARS的概率较高,BMI、吻合口距肛门距离、术前放化疗、术后吻合口瘘是影响患者术后排便功能的独立影响因素。Objective To investigate the incidence and influencing factors of low anterior resection syndrome(LARS)after laparoscopic rectal cancer radical anal preservation.Methods The patients who underwent laparoscopic anal preserving radical surgery for rectal cancer in the General Surgery Department of the Second Affiliated Hospital of Zhengzhou University from January 2018 to December 2018 were retrospectively analyzed.All the patients followed the principle of total mesorectal excision(TME)during the operation.Totally,105 patients who underwent laparoscopic rectal cancer radical anal preservation completed the final scale score and were finally included in this study,including 56 males and 49 females,aged(64.5±7.5)years,ranging from 35 years to 87 years.There were 23 cases of tumor TNM stageⅠ,11 cases of stageⅡ,and 71 cases of stageⅢ.Telephone,WeChat,outpatient,hospitalization,etc.were followed up to record the defecation situation of the patients 3,6,and 12 months after operation,and the defecation function of the research subjects was evaluated according to the LARS score.The subjects were divided into the LARS group(minor LARS and major LARS)and the non-LARS group(no LARS group)through the LARS quantitative table score.The incidence of LARS and the incidence of LARS were analyzed by comparing the differences in clinical data between the two groups of patients.Results All 105 patients successfully completed laparoscopic radical anuspreserving resection of rectal cancer without conversion to laparotomy.The operation time was(257±10)min,the intraoperative blood loss was(111.5±25.5)mL,the urinary catheter removal time after operation was(32±4)hours,and the first postoperative exhaust time was(6±1)days.105 patients completed the LARS score sheet 3,6 and 12 months after surgery.Univariate analysis showed:BMI(P=0.035),distance between anastomotic stoma and anus(P<0.01),local anal distance from the lower edge of tumor(P=0.003),preoperative radiotherapy and chemotherapy(P=0.014),postoperative anastomotic leakage(

关 键 词：直肠肿瘤 低位前切除综合征 腹腔镜手术 保肛根治术 危险因素 

分 类 号：R735.37[医药卫生—肿瘤]