直肠癌低位前切除综合征对患者心理、生理功能及生活质量的影响  

The risk factors of low anterior resection syndrome and its influence on psychological status and quality of life in rectal cancer patients

作　　者：贾国璞[1] 丁佩剑[2] 郑鑫[2] 孙勇[2] 白璐[2] 肖旭[3] Jia Guopu;Ding Peijian;Zheng Xin;Sun Yong;Bai Lu;Xiao Xu(Anorectal Department,Affiliated Hospital of Chengde Medical College,Chengde 067000,China;Department of Gastrointestinal Surgery,Affiliated Hospital of Chengde Medical College,Chengde 067000,China;Department of Pharmacy,Affiliated Hospital of Chengde Medical College,Chengde 067000,China)

机构地区：[1]承德医学院附属医院肛肠科,承德067000 [2]承德医学院附属医院胃肠外科,承德067000 [3]承德医学院附属医院药学部,承德067000

出　　处：《中华普通外科杂志》2023年第2期90-95,共6页Chinese Journal of General Surgery

基　　金：河北省重点研发计划项目(203777101D)。

摘　　要：目的探讨直肠癌低位前切除综合征(LARS)对患者心理、生理功能及生活质量的影响。方法回顾性分析2014年5月至2019年5月承德医学院附属医院收治的低位前切除200例直肠癌患者的临床资料,进行LARS量表评分,并进行单因素分析以及多因素Logistic回归分析。同时进行欧洲癌症研究与治疗组织生活质量核心问卷、心理痛苦管理筛查工具调查。结果本组患者在直肠癌保肛根治术后LARS发生率为43.0%。多因素分析显示,BMI≥24 kg/m2、吻合口瘘、吻合口距肛缘≤5 cm、术前放疗是直肠癌保肛根治术后LARS发生的独立危险因素(OR=2.123、15.109、7.302、12.682,均P<0.05)。术后重度LARS组患者总体健康水平、功能维度中躯体功能与情绪功能评分均显著低于无/轻度LARS组患者(t=5.788、8.831、8.745,均P<0.05),疲倦、腹泻评分均显著高于无/轻度LARS组患者(t=26.280、49.476,均P<0.05)。重度LARS组患者心理痛苦管理筛查工具中心理痛苦温度计评分及问题列表中交往问题、情绪问题、身体问题评分均显著高于无/轻度LARS组患者(t=4.246、6.563、5.913、4.408,均P<0.05)。重度LARS组与无/轻度LARS组男性患者勃起功能障碍与射精功能障碍发生率比较差异均无统计学意义(58.6%比51.6%、65.5%比58.1%,均P>0.05)。结论BMI≥24 kg/m2、吻合口瘘、吻合口距肛缘≤5 cm、术前放疗是直肠癌发生LARS的独立危险因素。Objective To investigate the effects of low anterior resection syndrome(LARS)on psychological and physical function and quality of life in patients with rectal cancer.Methods From May 2014 to May 2019,200 patients were included.LARS scale score was adopted,and the clinical and pathological data were collected.Univariate analysis and multivariate Logistic regression analysis were performed.the European Organization for Research and Treatment of Cancer Quality of Life core questionnaire and psychological distress management screening tool survey were conducted to evaluate the quality of life and psychological state.The incidence of postoperative sexual dysfunction in male patients was analyzed.Results The incidence of LARS was 43.0%.Multivariate analysis showed that body mass index≥24 kg/m2,anastomotic leakage,anastomotic distance≤5 cm from anal margin,and preoperative radiotherapy were independent risk factors for LARS(OR=2.123,15.109,7.302,12.682,all P<0.05).The overall health level and the scores of physical function and emotional function in the functional dimension of patients in the severe LARS group were significantly lower than those in the no/mild LARS group(t=5.788,8.831,8.745,all P<0.05).The scores of fatigue and diarrhea were significantly higher than those in the no/mild LARS group(t=26.280,49.476,all P<0.05).The psychological distress thermometer score and the scores of communication,emotional and physical problems in the severe LARS group were significantly higher than those in the no/mild LARS group(t=4.246,6.563,5.913,4.408,all P<0.05).Conclusion LARS is a common complication after Dixon procedure for rectal cancer.Body mass index≥24 kg/m2,anastomotic leakage,anastomotic distance from anal margin≤5 cm,and preoperative radiotherapy are independent risk factors for LARS.

关 键 词：直肠肿瘤 综合征 性功能障碍 生理性 生活质量 

分 类 号：R735.37[医药卫生—肿瘤]