低位前切除综合征评分：基于症状的直肠癌低位前切除术后肠功能障碍评分系统的开发和验证。

Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer.

机构信息

Colorectal Surgical Unit, Aarhus University Hospital, Denmark.

出版信息

Ann Surg. 2012 May;255(5):922-8. doi: 10.1097/SLA.0b013e31824f1c21.

DOI:10.1097/SLA.0b013e31824f1c21

PMID:22504191

Abstract

OBJECTIVE

The aim of this study was to develop and validate a scoring system for bowel dysfunction after low anterior resection (LAR) for rectal cancer, on the basis of symptoms and impact on quality of life (QoL).

BACKGROUND

LAR for rectal cancer often results in severe bowel dysfunction (LAR syndrome [LARS]) with incontinence, urgency, and frequent bowel movements. Several studies have investigated functional outcome, but the terminology is inconsistent hereby complicating comparison of results.

METHODS

Questionnaires regarding bowel function was sent to all 1143 LAR patients eligible for inclusion identified in the national Colorectal Cancer Database. Associations between items and QoL were computed by binomial regression analyses. The important items were selected and regression analysis was performed to find the adjusted risk ratios. Individual score values were designated items to form the LARS score, which was divided into "no LARS," "minor LARS," and "major LARS." Validity was tested by receiver operating characteristic (ROC) curve and Spearman's rank correlation and discriminant validity was tested by Student t tests.

RESULTS

A total of 961 patients returned completed questionnaires. The 5 most important items were "incontinence for flatus," "incontinence for liquid stools," "frequency," "clustering," and "urgency." The range (0-42) was divided into 0 to 20 (no LARS), 21 to 29 (minor LARS), and 30 to 42 (major LARS). The score showed good correlation and a high sensitivity (72.54%) and specificity (82.52%) for major LARS. Discriminant validity showed significant differences between groups with and without radiotherapy (P < 0.0001), tumor height more or less than 5 cm (P < 0.0001), and total mesorectal excision/partial mesorectal excision (P = 0.0163).

CONCLUSIONS

We have constructed a valid and reliable LARS score correlated to QoL--a simple tool for quick clinical evaluation of the severity of LARS.

摘要

目的

本研究旨在基于症状和对生活质量（QoL）的影响，为直肠癌前切除术（LAR）后建立并验证一种用于评估肠功能障碍的评分系统。

背景

直肠癌的 LAR 常导致严重的肠功能障碍（LAR 综合征[LARS]），伴有失禁、急迫和频繁的排便。有几项研究调查了功能结果，但术语不一致，因此使结果的比较变得复杂。

方法

将针对肠功能的问卷发送给全国结直肠癌数据库中确定的所有符合纳入条件的 1143 例 LAR 患者。通过二项回归分析计算项目与 QoL 之间的关联。选择重要项目，并进行回归分析以找到调整后的风险比。将各个分数指定为项目，形成 LARS 评分，该评分分为“无 LARS”“轻度 LARS”和“重度 LARS”。通过接收者操作特征（ROC）曲线和斯皮尔曼等级相关来测试有效性，并通过学生 t 检验来测试判别有效性。

结果

共 961 例患者返回了完整的问卷。最重要的 5 个项目是“排气失禁”“稀便失禁”“频率”“聚集”和“急迫”。范围（0-42）分为 0-20（无 LARS）、21-29（轻度 LARS）和 30-42（重度 LARS）。该评分显示出良好的相关性，对重度 LARS 的敏感性（72.54%）和特异性（82.52%）较高。判别有效性显示有和无放疗组（P < 0.0001）、肿瘤高度大于或小于 5cm（P < 0.0001）和完全/部分直肠系膜切除术组（P = 0.0163）之间存在显著差异。