Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, Japan.
Department of Radiology, Graduate School of Medicine, Osaka University, Osaka, Japan.
Surg Today. 2022 May;52(5):745-754. doi: 10.1007/s00595-022-02478-8. Epub 2022 Mar 24.
Approximately 90% of patients are thought to develop bowel dysfunction after low anterior resection (LAR). Although some prognostic factors have been reported, the volumes of defecation-related muscles have not been examined. This retrospective study investigated the association between the preoperative volume of defecation-related muscles and major LARS.
Forty-six patients who underwent LAR for rectal cancer between 2013 and 2020 in our institution were analyzed. They had no local residual tumor or local recurrence at the time of the study and no problems with their defecation function pre-operatively. Defecation-related muscle volume measurements were made before surgery, and the patients answered a low anterior resection syndrome (LARS) score questionnaire after surgery. The muscle volume was adjusted by the patient's height squared.
Twenty-seven patients (58.7%) developed major LARS. In the univariate analysis, sex, lateral lymph node dissection, and diverting ileostomy as well as muscle volume of the external anal sphincter, pubococcygeal + iliococcygeus muscle, and puborectal muscle were associated with major LARS. In a multivariate analysis, pubococcygeal + iliococcygeus muscle (< 5.96 ml/m) was the only factor (p = 0.02).
Measuring the volume of the defecation-related muscles may aid in predicting major LARS.
据认为，大约 90%的低位前切除术（LAR）后患者会出现肠功能障碍。虽然已经报道了一些预后因素，但排便相关肌肉的体积尚未被检查。本回顾性研究调查了术前排便相关肌肉体积与主要 LARS 的关系。
分析了 2013 年至 2020 年间在我院接受直肠癌 LAR 的 46 例患者。研究时他们没有局部残留肿瘤或局部复发，且术前排便功能没有问题。在手术前进行了排便相关肌肉体积测量，并在手术后对患者进行了低前切除综合征（LARS）评分问卷。肌肉体积通过患者身高的平方进行调整。
27 例（58.7%）患者发生主要 LARS。单因素分析显示，性别、侧方淋巴结清扫术、预防性回肠造口术以及肛外括约肌、耻骨尾骨肌+髂尾骨肌和耻骨直肠肌的肌肉体积与主要 LARS 相关。多因素分析显示，耻骨尾骨肌+髂尾骨肌（<5.96 ml/m）是唯一的因素（p=0.02）。
测量排便相关肌肉的体积可能有助于预测主要 LARS。
