腹腔镜下LAR术治疗低位直肠癌保肛术中钉仓数量与术后LARS的关系  

Relationship between the number of nail warehouses during sphincter-preserving surgery and LARS afterlaparoscopicLARforlowrectal cance

作　　者：王万川 麦广智 张晓槟 冯家豪 Wang Wanchuan;Mai Guangzhi;Zhang Xiaobing;Feng Jiahao(Department of Anorectal,Foshan Nanhai People's Hospital,Foshan Guangdong Province 528000,China)

机构地区：[1]佛山市南海区人民医院肛肠科,广东佛山528000

出　　处：《中华普外科手术学杂志（电子版）》2023年第5期491-496,共6页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的:探究腹腔镜下低位直肠前切除术(LAR)治疗低位直肠癌保肛术中钉仓数量与术后低位直肠前切除术综合征(LARS)的关系。方法:回顾性分析2018年6月至2021年6月于我院治疗的186例低位直肠癌患者的临床资料,根据LAR术后是否发生LARS,分为LARS组(n=54例)和无LARS组(n=132例)。评估患者术后肛门功能,应用SPSS 23.0软件对数据进行统计学分析。通过LASSO回归分析以及多因素Logistic回归分析影响术后LARS发生的危险因素,建立列线图预测模型并进行模型评价。采用Pearson分析术中钉仓数量与各危险因素的相关性。结果:患者术后肛门功能显著改善。LASSO回归分析筛选出6个预测因子,纳入多因素Logistic回归分析,结果显示,BMI≥24 kg/m^(2)、肿瘤下缘距肛缘距离<5 cm、有新辅助治疗、有吻合口漏、术中钉仓使用>2枚以及术后恢复时间≤6个月,均为术后LARS发生的独立危险因素(P<0.05);其中术中钉仓使用数量与吻合口漏的发生概率呈正相关(P<0.05)。受试者工作特征(ROC)曲线、校准曲线以及临床决策曲线分析法(DCA)的评价结果显示,该列线图预测模型的区分度、准确度以及有效性均较高。结论:BMI≥24 kg/m^(2)、肿瘤下缘距肛缘距离<5 cm、有新辅助治疗、有吻合口漏、术中钉仓使用>2枚以及术后恢复时间≤6个月,均为患者术后LARS发生的独立危险因素。本研究中所构建的列线图模型预测价值较高。术中钉仓使用数量越多,术后吻合口漏发生的风险越大。腹腔镜下LAR在低位直肠癌保肛术中疗效较好。Objective To investigate the relationship between the number of nail chambers in laparoscopic low anterior rectal resection(LAR)and postoperative low anterior rectal resection syndrome(LARS).Methods The clinical data of 186 patients with low rectal cancer treated in our hospital from June 2018 to June 2021 were retrospectively analyzed.According to whether LARS occurred after LAR,the patients were divided into LARS group(n=54 cases)and LARS group(n=132 cases)without LARS.The postoperative anal function of the patients was evaluated,and the data were statistically analyzed by SPSS 23.O software.Through LASSO regression analysis and multiple Logistic regression analysis,the risk factors affecting the occurrence of postoperative LARS were analyzed,and the nomogram prediction model was established and evaluated.The correlation between the number of nail bins and the risk factors was analyzed by Pearson.Results Postoperative anal function was significantly improved.Six predictors were selected by LASSO regression analysis,and multivariate Logistic regression analysis was included.The results showed that BMI24 kg/m^(2),the distance from the lower tumor margin to the anal margin was<5 cm,neoadjuvant therapy was present,anastomotic leakage was present,intraoperative nail storage was used>2,and postoperative recovery time was 6 months.All were independent risk factors for LARS after surgery(P<0.05).There was a positive correlation between the number of nail chambers used and the probability of anastomotic leakage(P<0.05).The evaluation results of receiver operating characteristic(ROC)curve,calibration curve and clinical decision curve analysis(DCA)showed that the prediction model of this column graph had high differentiation accuracy and effectiveness.Conclusion BMI24 kg/m²,distance from lower tumor margin to anal margin<5 cm,neoadjuvant therapy,anastomotic leakage,intraoperative nail bin use>2,and postoperative recovery time of 6 months were all independent risk factors for LARS.The nomogram model constructed in this st

关 键 词：直肠肿瘤 低位直肠前切除术 腹腔镜 综合征 列线图表 预测模型 

分 类 号：R735.37[医药卫生—肿瘤]