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[低位前切除术综合征的危险因素]

[Risk factors for low anterior resection syndrome].

作者信息

Wu G J, Jia W W, An Q, Yu T, Cao X L, Xiao G

机构信息

Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing 100730, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2018 Mar 27;98(12):917-920. doi: 10.3760/cma.j.issn.0376-2491.2018.12.008.

Abstract

While low anterior resection avoided a permanent stoma, it might also cause bowel dysfunction which can significantly impact patients' quality of life. The objective of this study was to identify the incidence and risk factors for the development of bowel dysfunction following rectal surgery. Patients undergoing anterior resection for rectal neoplasm between January 2010 and December 2015 were identified from a rectal cancer database at the Department of Gastrointestinal Surgery, Beijing Hospital. All patients were asked to fill in a low anterior resection syndrome (LARS) questionnaire. Clinical factors were compared between patients with major LARS and those with minor or no LARS using conditional logistic regression. There was 254 patients enrolled in the study. One hundred and eleven (44.1%) had major LARS symptoms. Neoadjuvant radiotherapy (=2.814, 95%: 1.097-5.561, <0.001), low tumor location (=3.568, 95%: 1.159-6.546, <0.001) and anastomotic leakage (=6.574, 95%: 1.689-15.367, <0.001) were independent risk factors for development of major LARS symptoms. For patients with high risk of low anterior resection syndrome, the potential for long-term poor functional results should be discussed with patients and form a part of the decision-making in individual treatment plans. Sphincter-preserving surgery should be performed in highly selected patients to avoid major bowel dysfunction.

摘要

虽然低位前切除术避免了永久性造口,但它也可能导致肠道功能障碍,这会对患者的生活质量产生重大影响。本研究的目的是确定直肠手术后肠道功能障碍发生的发生率和危险因素。从北京医院胃肠外科的直肠癌数据库中识别出2010年1月至2015年12月期间接受直肠肿瘤低位前切除术的患者。所有患者均被要求填写低位前切除综合征(LARS)问卷。使用条件逻辑回归比较有严重LARS的患者与有轻微或无LARS的患者之间的临床因素。该研究共纳入254例患者。111例(44.1%)有严重LARS症状。新辅助放疗(=2.814,95%:1.097 - 5.561,<0.001)、肿瘤位置低(=3.568,95%:1.159 - 6.546,<0.001)和吻合口漏(=6.574,95%:1.689 - 15.367,<0.001)是发生严重LARS症状的独立危险因素。对于低位前切除综合征高风险患者,应与患者讨论长期功能结果不佳的可能性,并将其作为个体治疗方案决策的一部分。应在经过严格筛选的患者中进行保留括约肌手术,以避免严重的肠道功能障碍。

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