直肠癌保肛术后患者发生低位前切除综合征及对肠道功能和生活质量影响的研究  

Current status of the occurrence of low anterior resection syndrome,bowel function and quality of life in patients after rectal cancer conserving surgery

作　　者：木尼瓦尔·买买提 蔡晓慧[2] 刘娟[3] 刘瑶 王丽君 葛磊[3,4] MUNIWAER Maimaiti;CAI Xiaohui;LIU Juan;LIU Yao;WANG Lijun;GE Lei(College of Nursing,Xinjiang Medical University,Urumqi,Xinjiang 830011,China;Affiliated Cancer Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830011,China;Department of Gastrointestinal Surgery,Affiliated Hospital of Guangdong Medical University,Zhanjiang,Guangdong 52400l,China)

机构地区：[1]新疆医科大学护理学院,新疆乌鲁木齐830011 [2]新疆医科大学附属肿瘤医院护理部,新疆乌鲁木齐830011 [3]新疆医科大学附属肿瘤医院胃肠外科,新疆乌鲁木齐830011 [4]广东医科大学附属医院胃肠外科,广东湛江524001

出　　处：《中华肿瘤防治杂志》2024年第1期33-38,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金(81960434);新疆维吾尔自治区自然科学基金(2022D01C296)。

摘　　要：目的探讨直肠癌保肛术后长期生存患者低位前切除综合征(LARS)发生情况,并调查对患者肠道功能和生活质量的影响。方法收集2010-01-01-2018-04-10在新疆医科大学附属肿瘤医院接受直肠癌保肛根治术并生存≥5年的135例患者临床资料,其中61例发生LARS(LARS组),74例未发生LARS(无LARS组)。无LARS组年龄为49.5(19.0~68.0)岁,LARS组为53.0(29.0~68.0)岁。采用单中心回顾性横断面研究方法,对入组的患者采用电话访谈的方式用量表进行调查,并分析这些患者LARS的发生情况、肠道功能及生活质量。对可能与LARS评分升高的相关因素根据变量类型进行单因素分析,分类变量采用χ^(2)检验,不符合正态分布的变量用Mann-Whitney U检验;二元logistic回归分析LARS的危险因素。结果单因素分析发现,肿瘤距肛缘距离和术后时间是影响肠道功能的危险因素(t=3.510,P=0.033;t=4.350,P=0.015)。对肿瘤距肛缘距离和术后时间行多元线性回归分析显示,肿瘤距肛缘>10和<5 cm者肠道功能的差异有统计学意义,P<0.05;术后5~7年和>10年患者肠道功能的差异有统计学意义,P<0.05。二元logistic回归分析显示,术前放疗和肿瘤距肛缘距离是影响LARS发生的高危因素(P=0.036;P=0.017),而术后时间在术后LARS发生风险的多因素分析中差异无统计学意义,P=0.109。生活质量得分中,躯体形象、便频、臀痛、肛门排气和排便尴尬的差异有统计学意义,均P<0.05。结论术前放疗和肿瘤距肛缘距离是影响LARS发生的高危因素,肿瘤距肛缘距离和术后时间是影响肠道功能的危险因素。直肠癌保肛术后长期生存患者仍有较高的LARS患病率,其中无LARS患者的生活质量较LARS者好。Objective To investigate the incidence of low anterior resection syndrome(LARS),and to investigate bowel function and quality of life(QOL)in patients with long-term survival after anorectal cancer preservation surgery.Methods Clinical data were collected from 135 patients who underwent anorectal conservative radical surgery for rectal cancer and survived for≥5 years at the Cancer Hospital of Xinjiang Medical University from 2010-01-01 to 2018-04-10,among which 61 cases developed LARS(LARS group)and 74 cases did not develop LARS(no LARS group).The age was 49.5(19.0-68.0)years in the no-LARS group and 53.0(29.0-68.0)years in the LARS group.Using a single-center retrospective cross-sectional study method,the enrolled patients were surveyed with a questionnaire using a telephone interview,and the occurrence of LARS,intestinal function,and quality of life were analyzed in these patients.Factors that may be associated with elevated LARS scores were analyzed by univariate analysis according to the type of variable,with the chisquare test for categorical variables and the Mann-Whitney Utest for variables that did not fit a normal distribution;binary logistic regression was used to analyze the risk factors for LARS.Results Univariate analysis revealed that the distance of the tumor from the anal verge and the postoperative time were risk factors for bowel function(t=3.510,P=0.033;t=4.350,P=0.015).Multiple linear regression analysis of the distance of the tumor from the anal verge and postoperative time showed that the difference in bowel function between those with a tumor>10cm and<5cm from the anal verge was statistically significant,P<0.05;and the difference in bowel function between those with 5-7years and those with>10years postoperatively was statistically significant,P<0.05.Binary logistic regression analysis showed that preoperative radiotherapy and tumor distance from the anal verge were high-risk factors affecting the occurrence of LARS(P=0.036;P=0.017),whereas postoperative time did not show a statistically si

关 键 词：直肠癌保肛术 低位前切除综合征 长期生存 肠道功能 生活质量 

分 类 号：R735.3[医药卫生—肿瘤]