Pi Yan-Na, Xiao Yi, Wang Zhi-Feng, Lin Guo-Le, Qiu Hui-Zhong, Fang Xiu-Cai
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
World J Clin Cases. 2022 Apr 26;10(12):3754-3763. doi: 10.12998/wjcc.v10.i12.3754.
The quality of life in patients who develop low anterior resection syndrome (LARS) after surgery for mid-low rectal cancer is seriously impaired. The underlying pathophysiological mechanism of LARS has not been fully investigated.
To assess anorectal function of mid-low rectal cancer patients developing LARS perioperatively.
Patients diagnosed with mid-low rectal cancer were included. The LARS score was used to evaluate defecation symptoms 3 and 6 mo after anterior resection or a stoma reversal procedure. Anorectal functions were assessed by three-dimensional high resolution anorectal manometry preoperatively and 3-6 mo after surgery.
The study population consisted of 24 patients. The total LARS score was decreased at 6 mo compared with 3 mo after surgery ( < 0.05), but 58.3% (14/24) lasted as major LARS at 6 mo after surgery. The length of the high-pressure zone of the anal sphincter was significantly shorter, the mean resting pressure and maximal squeeze pressure of the anus were significantly lower than those before surgery in all patients ( < 0.05), especially in the neoadjuvant therapy group after surgery ( = 18). The focal pressure defects of the anal canal were detected in 70.8% of patients, and those patients had higher LARS scores at 3 mo postoperatively than those without focal pressure defects ( < 0.05). Spastic peristaltic contractions from the new rectum to anus were detected in 45.8% of patients, which were associated with a higher LARS score at 3 mo postoperatively ( < 0.05).
The LARS score decreases over time after surgery in the majority of patients with mid-low rectal cancer. Anorectal dysfunctions, especially focal pressure defects of the anal canal and spastic peristaltic contractions from the new rectum to anus postoperatively, might be the major pathophysiological mechanisms of LARS.
中低位直肠癌手术后发生低位前切除综合征（LARS）的患者生活质量严重受损。LARS潜在的病理生理机制尚未得到充分研究。
评估发生LARS的中低位直肠癌患者围手术期的肛肠功能。
纳入诊断为中低位直肠癌的患者。采用LARS评分评估前切除或造口回纳术后3个月和6个月的排便症状。术前及术后3 - 6个月通过三维高分辨率肛肠测压评估肛肠功能。
研究人群包括24例患者。与术后3个月相比，术后6个月时LARS总分降低（<0.05），但术后6个月时有58.3%（14/24）的患者仍为重度LARS。所有患者肛门括约肌高压区长度均显著短于术前，肛门平均静息压和最大收缩压均显著低于术前（<0.05），尤其是术后接受新辅助治疗的患者（n = 18）。70.8%的患者检测到肛管局部压力缺陷，这些患者术后3个月时的LARS评分高于无局部压力缺陷的患者（<0.05）。45.8%的患者检测到从新直肠到肛门的痉挛性蠕动收缩，这与术后3个月时较高的LARS评分相关（<0.05）。
大多数中低位直肠癌患者术后LARS评分随时间降低。肛肠功能障碍，尤其是术后肛管局部压力缺陷和从新直肠到肛门的痉挛性蠕动收缩，可能是LARS的主要病理生理机制。
