Miyo Masaaki, Akizuki Emi, Okuya Koichi, Noda Ai, Ishii Masayuki, Miura Ryo, Ichihara Momoko, Toyota Maho, Okamoto Kohei, Ito Tatsuya, Akiyama Yuji, Takemasa Ichiro
Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan.
J Anus Rectum Colon. 2025 Jan 25;9(1):1-9. doi: 10.23922/jarc.2024-069. eCollection 2025.
Defecation disorders following rectal resection have long been overlooked as an inevitable surgical complication due to the lack of established diagnostic criteria or definitions. However, these disorders have been recently termed low anterior resection syndrome (LARS), which is a defecation disorder that occurs following rectal resection and impairs the patient's quality of life (QOL). The LARS score developed by Emmertsen et al., which is a patient-reported outcome measure to evaluate the severity of bowel dysfunction following rectal surgery by scoring the major symptoms of LARS, facilitates the diagnosis and assessment of LARS and enables international comparison and validation through the use of validated scores generated according to the international standards. Based on comparisons with other evaluation instruments, the use of the LARS score is strongly recommended internationally for LARS screening in patients following rectal resection. Recent findings have indicated that multiple pathophysiological changes, including reservoir function and evacuation of the neorectum, anal sphincter function, negative impact of a diverting stoma, autonomic denervation, and radiotherapy, are involved in the etiology of LARS. Due to the lack of established treatments and prevention of LARS, a suggested treatment chart for patients with LARS was presented in the Management Guidelines for Low Anterior Resection Syndrome (MANUEL) project. Future surgical treatment should focus not only on the radical cure of cancer and safety of treatment but also on the maintenance and improvement of QOL, with particular attention to the preservation of function. Particularly for rectal cancer, surgeons must formulate treatment plans that consider the prevention and treatment of LARS.
由于缺乏既定的诊断标准或定义，直肠切除术后的排便障碍长期以来一直被视为不可避免的手术并发症而被忽视。然而，这些障碍最近被称为低位前切除综合征（LARS），这是一种直肠切除术后发生的排便障碍，会损害患者的生活质量（QOL）。Emmertsen等人开发的LARS评分，是一种患者报告的结局指标，通过对LARS的主要症状进行评分来评估直肠手术后肠道功能障碍的严重程度，有助于LARS的诊断和评估，并能够通过使用根据国际标准生成的经过验证的评分进行国际比较和验证。基于与其他评估工具的比较，国际上强烈推荐使用LARS评分对直肠切除术后的患者进行LARS筛查。最近的研究结果表明，多种病理生理变化，包括新直肠的储袋功能和排空、肛门括约肌功能、转流造口的负面影响、自主神经去神经支配和放疗，都与LARS的病因有关。由于缺乏既定的LARS治疗方法和预防措施，低位前切除综合征管理指南（MANUEL）项目中提出了一份针对LARS患者的建议治疗图表。未来的手术治疗不仅应关注癌症的根治和治疗的安全性，还应关注生活质量的维持和改善，尤其要注意功能的保留。特别是对于直肠癌，外科医生必须制定考虑到LARS预防和治疗的治疗计划。
