影响直肠癌保肛根治术后发生LARS的相关因素分析  

Analysis of Related Factors Affecting the Occurrence of LARS After Anal Conserving Radical Surgery for Rectal Cancer

作　　者：张芳弟[1] 万雪 闫雪南 Zhang Fangdi;Wan Xue;Yan Xuenan(Colorectal Surgery Department,Henan Hongli Hospital,Xinxiang,Henan,453400,China)

机构地区：[1]河南宏力医院肛肠外科,河南新乡453400

出　　处：《黑龙江医学》2025年第7期786-789,共4页Heilongjiang Medical Journal

摘　　要：目的:探讨腹腔镜直肠癌保肛根治术后并发低位前切除综合征(LARS)的高危因素。方法:回顾性分析2019年1月—2023年12月河南宏力医院77例行腹腔镜直肠癌保肛根治术并顺利出院患者的临床资料,在随访过程中,根据患者是否发生LARS分为LARS组和无LARS组。分析对比两组患者基础性疾病等资料及临床指标,将差异有统计学意义的变量的项目纳入logistics回归分析,获取腹腔镜直肠癌保肛根治术后并发LARS的独立危险因素。结果:LARS组BMI≥24 kg/m^(2)、肿瘤距肛缘距离≤7 cm、行新辅助化疗、吻合口瘘、术后恢复时间≤6个月的发生率均高于无LARS组,差异均有统计学意义(χ^(2)=5.427、8.920、12.585、10.073、5.898,P<0.05);logsitic回归分析结果显示,BMI≥24 kg/m^(2)、肿瘤距肛缘距离≤7 cm、行新辅助化疗、吻合口瘘、术后恢复时间≤6个月是腹腔镜直肠癌保肛根治术后并发LARS的高危因素(OR=3.048、4.267、5.867、4.838、3.200,P<0.05)。结论:腹腔镜直肠癌保肛根治术后并发LARS的风险极高,与患者肥胖或超重、肿瘤距肛缘距离、行新辅助化疗、吻合口瘘、术后恢复时间短有关,临床可根据上述因素及早采取干预措施。Objective:To investigate the high risk factors of low anterior resection syndrome(LARS)after laparoscopic anal saving surgery for rectal cancer.Methods:The clinical data of 77 patients who were successfully discharged from the hospital after laparoscopic anal preserving radical resection for rectal cancer from January 2019 to December 2023 were retrospectively analyzed.In the follow-up process,patients were divided into the LARS group and the LARS group without LARS according to whether they had LARS.The data of underlying diseases and clinical indicators of the two groups were analyzed and compared,and the items with differences in test were included in logistics regression analysis to obtain the independent risk factors of LARS complicated after laparoscopic anal preservation radical surgery for rectal cancer.Results:The incidence rates of BMI≥24 kg/m^(2),tumor distance from anal margin≤7 cm,neoadjuvant chemotherapy,anastomotic fistula,and postoperative recovery time≤6 months in LARS group were higher than those in no LARS group,with statistically significant difference(χ^(2)=5.427,8.920,12.585,10.073,5.898;P<0.05).Logsitic regression analysis results show that BMI≥24 kg/m^(2),tumor distance from anal margin≤7 cm,neoadjuvant chemotherapy,anastomotic fistula,and postoperative recovery time≤6 months were the risk factors for LARS after laparoscopic anal preservation for rectal cancer(OR=3.048,4.267,5.867,4.838,3.200;P<0.05).Conclusion:The risk of LARS after laparoscopic anal preservation for rectal cancer is very high,which is related to obesity or overweight patients,tumor distance from anal margin,neoadjuvant chemotherapy,anastomotic fistula,and short postoperative recovery time.Clinical intervention measures can be taken early according to the above factors.

关 键 词：直肠癌保肛根治术 低位前切除综合征 肥胖 低位肿瘤 新辅助化疗 吻合口瘘 

分 类 号：R735.37[医药卫生—肿瘤]