全直肠系膜切除术后低位前切除综合征的发生率及相关危险因素分析  

Incidence of Low Anterior Resection Syndrome after Total Mesorectal Excision and Its Risk Factors

作　　者：李洲[1] 马勇[1] 方仕旭 曾柯瑞 Li Zhou;Ma Yong;Fang Shixu;Zeng Kerui(Department of General Surgery,Zigong First people’s Hospital,Zigong 643000,Sichuan,China)

机构地区：[1]自贡市第一人民医院普通外科,四川自贡643000

出　　处：《肿瘤预防与治疗》2022年第2期169-174,共6页Journal of Cancer Control And Treatment

摘　　要：目的:探讨全直肠系膜切除术(totalmesorectalexcision,TME)后低位前切除综合征(lowanteriorresection syndrome,LARS)的发生率及相关危险因素。方法:纳入2017年1月至2019年12月在我院普外科行TME的直肠癌术后患者200例作为研究对象,采用LARS量表将患者分为LARS组(包括轻度和重度LARS)和无LARS组,收集患者的相关临床资料,采用多因素Logistic回归模型分析TME术后发生LARS的相关危险因素。结果:有188例(94.0%)在随访期间完成了LARS评分,79例(42.0%)患者术后发生重度LARS、49例(26.1%)发生轻度LARS、60例(31.9%)无LARS症状。术后3、6、12个月LARS的发生率分别为43.6%(82/188)、28.7%(54/188)、19.1%(36/188)。患者术后12个月LARS的发生率明显低于术后6个月(χ^(2)=4.733,P=0.030)和术后3个月的发生率(χ^(2)=26.134,P<0.001)。肿瘤下缘距肛缘距离<5cm(OR=2.375,95%CI:1.269~7.064)、术前新辅助放化疗(OR=3.007,95%CI:1.161~7.759)、术后放化疗(OR=3.572,95%CI:1.160~6.456)是影响TME直肠癌患者术后发生LARS的独立危险因素(均P<0.05)。结论:直肠癌行TME保肛根治术患者术后LARS综合征具有较高的发生率,肿瘤下缘距肛缘距离<5cm、术前新辅助放化疗、术后放化疗是患者术后LARS发生的独立危险因素。Objective: To investigate the incidence of low anterior resection syndrome(LARS) after total mesorectal excision(TME) and its risk factors. Methods: 200 rectal cancer patients who underwent TME in our hospital from January 2017 to December 2019 were selected as the research objects. The patients were assigned to the LARS group(including mild and severe LARS) and the non-LARS group according to the LARS score. Clinical data of patients were collected, and risk factors of LARS after TME were analyzed by multivariate logistic regression models. Results: According to the LARS scores of 188 cases(94.0%) received during the follow-up, 79 cases(42.0%) were severe, 49 cases(26.1%) were mild, and 60 cases(31.9%) had no symptoms. The incidences of LARS were 43.6%(82/188), 28.7%(54/188) and 19.1%(36/188) 3, 6 and 12 months after TME;and that at the 12 th months was significantly lower than those at the 6 th months(χ;=4.733, P=0.030) and the 3 rd months(χ;=26.134, P<0.001). A less than 5 cm distance between lower tumor margin and anal verge(OR=2.375, 95% CI: 1.269-7.064), preoperative neoadjuvant chemoradiotherapy(OR=3.007, 95% CI: 1.161-7.759) and postoperative radiotherapy and chemotherapy(OR=3.572, 95% CI: 1.160-6.456) were independent risk factors for LARS after TME(all P<0.05). Conclusion: There is a high incidence of LARS in rectal cancer patients who underwent TME. A less than 5 cm distance between lower tumor margin and anal verge, preoperative neoadjuvant chemoradiotherapy and postoperative radiotherapy and chemotherapy were independent risk factors for LARS after TME.

关 键 词：直肠癌 全直肠系膜切除术 低位前切除综合征 危险因素 

分 类 号：R735.3[医药卫生—肿瘤]