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直肠癌患者肠造口还纳术后发生低位前切除综合征(LARS)的风险因素。

Risk factors of the low anterior resection syndrome (LARS) after ileostomy reversal in rectal cancer patient.

机构信息

Department of Nursing, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei Province, China.

Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei Province, China.

出版信息

Sci Rep. 2024 Nov 16;14(1):28281. doi: 10.1038/s41598-024-79283-5.

Abstract

This study is aimed at identifying risk factors of Low Anterior Resection Syndrome following ileostomy reversal in rectal cancer patients who had undergone preventive ileostomy. This retrospective analysis was conducted on a cohort of 605 patients treated at the Fourth Hospital of Hebei Medical University between January 2018 and December 2021. These patients were grouped based on LARS score, and Clinical and follow-up data were collected to conduct univariate analyses of potential factors influencing LARS occurrence based on variable type. Variables with statistical significance were included in a logistic regression model to analyze potential influences on the occurrence of LARS. Univariate and Multivariate logistic regression analysis showed that N2 stage (OR = 2.290 95%CI: 1.076-4.873, P = 0.031), chemoradiotherapy (OR = 2.271, 95%CI: 1.246-4.138, P = 0.007), and anastomosis height (OR = 0.836, 95%CI: 0.717-0.975, P = 0.022) were independent influences on the occurrence of LARS. In model 3 (adjusting for all covariates), the relationship between anastomotic height and patient LARS status showed a negative correlation. In subgroup analyses, there were significant differences in the effect of anastomotic height on LARS in subgroups with different hemoglobin concentrations. A high occurrence rate of LARS is observed in rectal cancer patients with preventive ileostomy reversal. N2 stage, history of chemoradiotherapy, and anastomotic height are independent influence factors for the occurrence of major LARS after ileostomy reversal.

摘要

本研究旨在确定预防性回肠造口术逆转后直肠癌患者发生低位前切除综合征(LARS)的风险因素。本回顾性分析纳入了 2018 年 1 月至 2021 年 12 月在河北医科大学第四医院接受治疗的 605 例患者。根据 LARS 评分对这些患者进行分组,并收集临床和随访数据,根据变量类型对潜在影响 LARS 发生的因素进行单因素分析。将具有统计学意义的变量纳入逻辑回归模型,以分析对 LARS 发生的潜在影响。单因素和多因素逻辑回归分析显示,N2 期(OR=2.290,95%CI:1.076-4.873,P=0.031)、放化疗(OR=2.271,95%CI:1.246-4.138,P=0.007)和吻合口高度(OR=0.836,95%CI:0.717-0.975,P=0.022)是影响 LARS 发生的独立因素。在模型 3(调整所有协变量后)中,吻合口高度与患者 LARS 状态之间的关系呈负相关。在亚组分析中,不同血红蛋白浓度亚组中吻合口高度对 LARS 的影响存在显著差异。预防性回肠造口术逆转后直肠癌患者 LARS 发生率较高。N2 期、放化疗史和吻合口高度是回肠造口术逆转后发生严重 LARS 的独立影响因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a60/11569193/e9e3ecb20bef/41598_2024_79283_Fig1_HTML.jpg

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