低位直肠癌经括约肌间切除术后肛门功能和症状特异生活质量的前瞻性观察研究  

A prospective observational study on functional outcomes and condition-specific quality of life after intersphincteric resection for low rectal cancer

作　　者：张斌 叶小飞[2] 贾宜娜 卓光鑽 姜红红 邹程程 丁健华 Zhang Bin;Ye Xiaofei;Jia Yina;Zhuo Guangzuan;Jiang Honghong;Zou Chengcheng;Ding Jianhua(Department of Colorectal Surgery,Characteristic Medical Center of People′s Liberation Army Rocket Force,Beijing 100088,China;Department of Health Statistics,Naval Medical University,Shanghai 200433,China;Jinzhou Medical University Joint People′s Liberation Army Rocket Force Characteristic Medical Center Training Base,Beijing 100088,China)

机构地区：[1]火箭军特色医学中心肛肠外科,北京100088 [2]海军军医大学军队卫生统计学教研室,上海200433 [3]锦州医科大学联合火箭军特色医学中心培养基地,北京100088

出　　处：《中华外科杂志》2024年第10期953-959,共7页Chinese Journal of Surgery

基　　金：国家自然科学基金(82172845);首都临床诊疗技术研究及转化应用(Z211100002921044)。

摘　　要：目的探讨经括约肌间切除(ISR)术后低位直肠癌患者的肛门功能及症状特异生活质量(CSQoL)。方法本研究为前瞻性观察研究。纳入2020年5月至2023年4月在火箭军特色医学中心肛肠外科行腹腔镜ISR保留肛门的低位直肠癌患者。通过广义估计方程评估预防性造口还纳后3~6个月、12个月、24~36个月的肛门功能和CSQoL变化的差异。功能评估采用传统低位前切除综合征(LARS)和Wexner失禁评分(WIS),并依据WIS量表的症状频率和赋值探索性评估LARS国际共识定义的16项症状和结局变量(每项指标赋值0~4分,总分0~64分,定义为探索性LARS严重程度评分);CSQoL采用大便失禁生活质量问卷(FIQL)和视觉模拟评分(VAS)进行评估。结果研究共纳入患者90例,其中男性64例,女性26例,年龄为(58.6±10.4)岁(范围:28~79岁),肿瘤下极距肛缘的距离[M(IQR)]3.0(1.5)cm(范围:1.0~5.0 cm)。造口还纳后3~6个月时完成随访55例,12个月时59例,24~36个月时40例。ISR术后各时间点患者CSQoL不断改善[FIQL评分:(2.33±0.69)分比(2.40±0.66)分比(2.79±0.76)分,χ^(2)=11.703,P=0.003;VAS:(5.31±1.65)分比(5.61±1.90)分比(6.58±1.92)分,χ^(2)=12.781,P=0.002]。而各时间点之间WIS和传统LARS评分差异无统计学意义(P值均>0.05)。排空困难是ISR患者术后最常见的LARS症状,而肠功能不满意为最常见临床结局。探索性LARS严重程度评分在ISR术后明显改善[34(14)比31(13)比23(17),χ^(2)=13.952,P=0.001],且与FIQL强相关(rs=-0.72,P<0.01)。结论尽管ISR术后LARS症状持续存在,但患者CSQoL和功能结果不断改善;采用最新国际共识的变量指标评估ISR术后LARS严重程度可能更全面地反映患者生活质量。Objective To investigate functional outcomes and condition-specific quality-of-life(CSQoL)after intersphincteric resection(ISR)in patients with low rectal cancer using traditional and exploratory questionnaires.Methods A prospective observational study was conducted in the Characteristic Medical Center of the People′s Liberation Army Rocket Force.Patients with low rectal cancer who underwent ISR with ileostomy reversal from May 2020 to April 2023 were enrolled.An electronic self-assessment survey was sent to enrolled patients at 3 to 6,12,and 24 to 36 months after reversal,and differences in functional and CSQoL results between the 3 groups were analyzed with generalized estimation equations.Functional outcomes were determined by the Wexner incontinence score(WIS)and the low anterior resection syndrome(LARS)score.In line with the five frequency responses ranging from never(score 0)to always(score 4)defined by the WIS,an exploratory survey was used to measure the severity of 16 LARS-specific variables confirmed by the latest international Delphi consensus.Furthermore,CSQoL was evaluated using the fecal incontinence quality-of-life scale(FIQL)and the visual analog scale(VAS).Results A total of 90 patients were enrolled in the study.There were 64 males and 26 females,aged(58.6±10.4)years(range:28 to 79 years).The median distance from the distal tumor margin to the anal verge(M(IQR))was 3.0(1.5)cm(range:1.0 to 5.0 cm).There were 55 patients who completed the questionnaires at 3 to 6 months,59 patients at 12 months,and 40 patients at 24 to 36 months of follow-up,respectively.The summary score of FIQL and VAS improved significantly after reversal(2.33±0.69 vs.2.40±0.66 vs.2.79±0.76,χ^(2)=11.703,P=0.003;5.31±1.65 vs.5.61±1.90 vs.6.58±1.92,χ^(2)=12.781,P=0.002),but the differences in the WIS and LARS score did not reach statistical significance(both P>0.05).The survey responses for the LARS-specific variables indicated that“emptying difficulties”and“dissatisfaction with the bowels”were the most frequen

关 键 词：直肠肿瘤 手术后并发症 经括约肌间切除术 低位前切除综合征 生活质量 肛门功能 

分 类 号：R735.37[医药卫生—肿瘤]