低位直肠癌新辅助化疗联合保肛术后发生低位前切除综合征的现况调查  

Low anterior resection syndrome after neoadjuvant chemotherapy followed by restorative surgery for low rectal cancer:a cross-sectional

作　　者：黄斌杰[1,3] 朱苗苗 吴雅丽 秦启元 何炎炯 周佐霖 黄小艳 王辉[1] 马腾辉[1,3] Huang Binjie;Zhu Miaomiao;Wu Yali;Qin Qiyuan;He Yanjiong;Zhou Zuolin;Huang Xiaoyan;Wang Hui;Ma Tenghui(Department of General Surgery(Colorectal Surgery),Sirth Affiliated Hospital,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases,Sirth Affiliated Hospital,Sun Yat-sen University,Biomedical Innovation Center,Sicth Affiliated Hospital,Sun Yat-sen University,Guangdong Guangzhou,510655;Department of Pharmacy,Sixth Affiliated Hospital,Sun Yat-sen University,Guangdong Guangzhou,510655;Department of Clinical Nutrition&Microecology,Sirth Affiliated Hospital,Sun Yat-sen University,Guangdong Guangzhou,510655;Department of Gastrointestinal Surgery,National Cancer Center/National Clinical Research Center for Cancer,Cancer Hospital and Shenzhen Hospital,Guangdong Shenzhen,518116;Department of Anorectal Surgery,the First af filiated hospital of shenzhen University/Second Municipal People's Hospital,Guangdong Shenzhen,518035)

机构地区：[1]中山大学附属第六医院普通外科(结直肠外科、放射性肠损伤中心)广东省结直肠盆底疾病研究重点实验室广州市黄埔区中六生物医学创新研究院,广东广州510655 [2]中山大学附属第六医院药学部,广东广州510655 [3]中山大学附属第六医院临床营养与微生态科,广东广州510655 [4]中国医学科学院肿瘤医院深圳医院胃肠外科,广东深圳518116 [5]深圳大学第一附属医院(深圳市第二人民医院)肛肠外科,广东深圳518035

出　　处：《腹部外科》2023年第6期450-456,462,共8页Journal of Abdominal Surgery

基　　金：国家临床重点专科、广东省消化系统疾病临床医学研究中心项目(2020B1111170004);中山大学附属第六医院“1010”计划[1010CG(2022)-09]。

摘　　要：目的调查低位直肠癌病人新辅助化疗联合保肛术后低位前切除综合征(low anterior resection syndrome,LARS)的发生情况并分析其危险因素。方法采用横断面调查方法,分析2010年9月至2020年12月期间,在中山大学附属第六医院行新辅助化疗的直肠癌病人的临床资料,纳入接受保肛手术的低位(肿瘤下缘距肛缘<5 cm)直肠癌病人,同时排除接受盆腔放疗、造口未还纳或重新造口以及肿瘤复发或转移的病人。使用LARS量表评估上述病人恢复肠道连续性1年后的肠道功能情况,根据LARS量表评分将病人分为无LARS(0~20分)、轻度LARS(21~29分)及重度LARS(30~42分),将病人基线资料、肿瘤特征、手术方式及术后并发症等可能影响病人术后肠道功能的相关因素纳入logistic回归分析模型,进行总体LARS及重度LARS发生风险的单因素和多因素分析。结果纳入分析病人129例,失访病人30例,随访病例与失访病例两组仅在术前体重指数[(23.0±3.0)比(20.8±2.9)kg/m~2]及术后T分期(pT_(0~2):62.8%比26.7%)上的差异具有统计学意义(P<0.05)。在纳入分析的129例病人中,男性84例,年龄(56.4±12.4)岁,肿瘤高度(3.8±0.7)cm;术前均接受CapeOX/FOLFOX两药(78.3%)或FOLFOXIRI三药方案化疗,29.5%(38/129)的病人接受经肛经腹双镜联合直肠癌根治术,71.4%(92/129)的病人行括约肌间切除,74.4%(96/129)的病人接受预防性造口,13.2%(17/129)的病人术后出现吻合口漏。术后中位随访时间为3.9(1.0~10.4)年,总体LARS发生率为55.0%(71/129),重度LARS发生率为24.0%(31/129),排便困难(排便<1次/d)与簇状排便(1 h内反复排便)是最常见的肠道症状。logistic单因素回归分析显示,发生总体LARS的危险因素为:男性(OR=2.565,P=0.012)、术后发生吻合口漏(OR=4.503,P=0.015)、恢复肠道连续性时间≤4年(OR=2.285,P=0.02);发生重度LARS的危险因素为:男性(OR=2.754,P=0.037)、术后发生吻合口漏(OR=6.190,P=0.001)、括约肌间切除(ORObjective To explore the occurrences and risk factors of low anterior resection syndrome(LARS)in low rectal cancer patients with neoadjuvant chemotherapy followed by curative restorative anterior resection.Methods For this cross-sectional study,129 low rectal cancer patients on neoadjuvant chemotherapy were recruited at Sixth Affiliated Hospital between September,2010 and December,2020.Those with curative restorative anterior resection were included while those with pelvic radiation,stoma without closure and local tumor recurrence or metastasis excluded.LARS score was utilized for assessing bowel function at least 1 year post-restoration.They were categorized into three groups of no LARS(0-20 points),mild LARS(21-29 points)and severe LARS(30-42 points).Baseline profiles,tumor features,treatment strategies and postoperative complications were included into Logistic regression analysis for assessing the risk factors for overall and severe LARS.Results 30 patients became lost to follow-ups.Only in preoperative body mass index(23.0±3.0 vs.20.8±2.9)and pathological T stage(pT0-2:62.8%vs 26.7%)(P<0.05),differed significantly between the follow-up and lost-follow-up group.There were 84 males and 45 females with an average age of(56.4±12.4)year and an average tumor diameter of(3.8±0.7)cm.Preoperative chemotherapeutic regimen CapeOX/FOLFOX(78.3%)or FOLFOXIRI was offered.29.5%(38/129)underwent transanal and transabdominal laparoscopy,71.4%(92/129)had intersphincteric resection,74.4%(96/129)received prophylactic stomas and 13.2%(17/129)developed postoperative anastomotic leakage.During a median follow-up period of 3.9(1.0-10.4)year,there were an overall LARS incidence of 55.0%(71/129)and a severe LARS incidence of 24.0%(31/129).Constipation(defecation less than once daily)and frequent defecation within 1h were the most common symptoms.Logistic univariate regression analysis indicated that male gender(OR=2.565,P=0.012),anastomotic leakage(OR=4.503,P=0.015)and bowel continuity restoration time<4 year(OR=2.285,P=0.021)were

关 键 词：低位直肠癌 新辅助化疗 低位前切除综合征 吻合口漏 

分 类 号：R735.7[医药卫生—肿瘤]