直肠癌保肛术后低位前切除综合征发生率、恢复情况及影响因素的回顾性分析

发布时间：2018-06-06 01:09

本文选题：直肠癌 + 保肛手术　；参考：《第三军医大学学报》2017年10期

【摘要】：目的探讨直肠癌患者保肛术后低位前切除综合征(low anterior resection syndrome,LARS)的发生率、恢复情况及影响因素。方法回顾性分析2012年5月至2015年1月第三军医大学新桥医院普通外科确诊为直肠癌并行保肛根治术的患者337例,其中男性208例,女性129例,年龄(61.03±11.32)岁。收集患者临床、病理及随访资料,选择可能对直肠癌保肛术后LARS发生产生影响的临床病理因素进行单因素及多因素Logistic回归分析,并分析术后恢复时间及骨盆径线对LARS的影响。结果 337例直肠癌患者LARS评分均数为14.08(0~41),126例(37.4%)有LARS症状,其中重度LARS占总例数的18.7%。多因素Logistic回归分析显示:吻合口位置越低、术前放疗、术后恢复时间越短均是患者术后存在LARS的独立危险因素(OR1,P0.05)。术后不同时间段的直肠癌患者LARS评分比较显示:与术后6个月内比较,术后6~18个月LARS评分呈逐步且显著下降的趋势(P0.01)。对于手术18个月后的患者研究显示:吻合口距肛缘5 cm直肠癌患者LARS发生率显著高于吻合口距肛缘≥5 cm组(P0.05);骨盆径线资料对比分析发现,吻合口距肛缘5 cm直肠癌患者中,LARS组坐骨棘间径显著小于无LARS组(P0.05)。结论 LARS是直肠癌特别是低位直肠癌保肛术后的常见并发症,吻合口位置、术前放疗及术后恢复时间均为影响LARS发生发展的重要因素;直肠癌患者术后LARS症状出现显著改善至少需6个月以上;骨盆横径特别是坐骨棘间径大小可预测低位直肠癌术后LARS发生及恢复情况。
[Abstract]:Objective to investigate the incidence, recovery and influencing factors of low anterior resection syndrome (LARS) after anus preserving surgery in rectal cancer patients. Methods 337 cases of rectal cancer and radical resection of rectal cancer were retrospectively analyzed from May 2012 to January 2015 in general surgery of Xinqiao Hospital of Third Military Medical University, of which 20 of them were male. 8 cases, 129 women, age (61.03 + 11.32) years of age. Collect the patients' clinical, pathological and follow-up data, select the clinicopathological factors that may affect the occurrence of LARS after rectal cancer surgery, and analyze the single factor and multiple factor Logistic regression analysis, and analyze the postoperative recovery time and the effect of the pelvis line on the LARS. Results 337 cases of rectal cancer patients LA RS scores were 14.08 (0~41), and 126 cases (37.4%) had LARS symptoms. The 18.7%. multiple factor Logistic regression analysis of severe LARS showed that the lower the anastomotic position, the preoperative radiotherapy and the shorter recovery time were independent risk factors for LARS after operation (OR1, P0.05). The LARS score of the rectal cancer patients at different time periods after operation. Compared with 6 months after the operation, the LARS score of 6~18 months after operation was gradually and significantly decreased (P0.01). For 18 months after the operation, the study showed that the incidence of LARS in 5 cm rectal cancer patients with anastomotic margin of anal margin was significantly higher than that of the group of more than 5 cm (P0.05) with the anastomotic distance to the anal margin, and the pelvis line data were compared and analyzed and the anastomotic distance was found. Among the 5 cm rectal cancer patients with rectal cancer, the sciatic spine diameter of group LARS was significantly less than that of the non LARS group (P0.05). Conclusion LARS is a common complication after the operation of rectal cancer especially low rectal cancer. The location of the anastomosis, the preoperative radiotherapy and the postoperative recovery time are all important factors affecting the development of LARS, and the LARS symptoms of rectal cancer patients have been significantly altered. Good will take at least 6 months. Pelvic transverse diameter, especially the diameter of the interspinous spine, can predict the occurrence and recovery of LARS after low rectal cancer.
【作者单位】：第三军医大学新桥医院普通外科;
【分类号】：R735.37

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