直肠癌低位前切除术中保留左结肠动脉对低位前切除综合征发生率的影响  

The effect of left colic artery preservation on low anterior resection syndrome in patients of rectal cancer

作　　者：张峻岭[1] 丰硕 吴涛[1] 王长友 陈国卫[1] 姜勇[1] 孙烈[1] 刘涛[1] 王金贵 窦伟冬 武颖超[1] 汪欣[1] Zhang Junling;Feng Shuo;Wu Tao;Wang Changyou;Chen Guowei;Jiang Yong;Sun Lie;Liu Tao;Wang Jingui;Dou Weidong;Wu Yingchao;Wang Xin(Department of Gastrointestinal Surgery,the First Hospital,Beijing University,Beijing 100034,China;Department of Gastrointestinal Oncology Surgery,University of Huabeiligong,Tang Shan 063210,China)

机构地区：[1]北京大学第一医院胃肠外科,北京100034 [2]华北理工大学胃肠肿瘤外科,唐山063210

出　　处：《中华普通外科杂志》2025年第2期88-93,共6页Chinese Journal of General Surgery

基　　金：北京大学第一医院青年临床研究专项基金项目(2021CR03);国家自然科学基金(81641098, 82372860);北京大学第一医院交叉临床专项(2022CR13);国家重大疾病多学科合作诊疗能力建设项目;北京大学医学部青年培育基金(BMU2020PYB026)。

摘　　要：目的探讨低位直肠癌患者术中保留左结肠动脉(LCA)对术后短期肛门功能和生活质量的影响。方法前瞻性纳入2022年1月至2023年12月期间北京大学第一医院胃肠外科的292例直肠癌患者,根据手术中是否保留LCA将患者分为两组,采用LARS量表和EORTC QLQ-CR29生活质量问卷评估术后肛门功能和生活质量。结果两组在手术出血量、根部淋巴结清扫数量、术后排气时间方面差异均无统计学意义(均P>0.05)。保留LCA组在术后1个月和3个月的LARS评分低于非保留组,特别是在排气失禁、稀便漏出和排便次数方面差异均有统计学意义(均P<0.05)。EORTC QLQ-CR29生活质量评分显示,保留LCA组在术后排尿困难(P=0.007)、尿失禁(P=0.006)、排黏液便(P=0.009)和排便失禁症状(P<0.001)的恢复上优于非保留组。保留LCA组术后阳痿症状恢复较快(P=0.043),但两组在术后3个月差异无统计学意义(P>0.05)。结论在直肠癌低位前切除术中保留LCA有助于降低术后低位前切除综合征的发生率,泌尿系统症状及性功能损害较轻。Objective:To investigate the effect of left colonic artery(LCA)preservation on rectal cancer patients'short-term postoperative anal function and quality of life.Methods:Two-hundred ninty-two patients with rectal cancer at the Department of Gastrointestinal Surgery of Peking University First Hospital between Jan 2022 and Dec 2023 were enrolled.The patients were divided into two groups according to whether the LCA was preserved during surgery or not.The LARS scale and EORTC QLQ-CR29 quality of life questionnaire were used to assess postoperative anal function and quality of life.Results:There were no significant differences between the two groups in terms of the amount of surgical blood loss and the number of lymph node dissections in the root No.253 group and the time to postoperative voiding(all P>0.05).However,the LARS scores at 1 and 3 months postoperatively were significantly lower in the preserved LCA group than in the LCA nonpreserved group,especially for gas incontinence,loose stool leakage,and number of bowel movements(all P<0.05).The EORTC QLQ-CR29 scores showed that the LCA preserved group recovered significantly better than the non-preserved group in terms of postoperative voiding dysfunction(P=0.007),urinary incontinence(P=0.006),mucus discharge(P=0.009),and fecal incontinence symptoms(P<0.001).Male sexual dysfunction recovery was quicker in the preserved LCA group(P=0.043),but there was no significant difference between the two groups at 3 months postoperatively(P>0.05).Conclusion:Preservation of the left colonic artery in low anterior resection of rectal cancer helps to reduce the incidence of postoperative low anterior resection syndrome,improve genitourinary symptoms,and improve patients'quality of life.

关 键 词：直肠肿瘤 结肠动脉 综合征 泌尿生殖功能 直肠切除术 

分 类 号：R735.37[医药卫生—肿瘤]