【作者】 刘博；

【导师】 刘卓；

【作者基本信息】 吉林大学 ， 外科学（专业学位）， 2022， 硕士

【摘要】 目的:直肠前切除综合征(low anterior resection syndrome,LARS),是直肠癌保肛手术后一种发生率较高的并发症,对患者生活质量和心理都有影响。本次研究通过回顾性分析直肠前切除综合征发生的相关危险因素,为临床手术医生提供相关参考,以降低术后直肠前切除综合征的发生率。方法:回顾性分析纳入本次研究的直肠癌保肛手术的179例患者,将91例未出现直肠前切除综合征的患者纳入对照组,88例出现直肠前切除综合征的患者纳入研究组。结合相关病历资料,收集以下可能与直肠前切除综合征发生相关的因素并加以分析:性别,年龄,体重指数BMI,术前是否有合并其他系统疾病,术前是否行新辅助治疗,手术时间,术中出血量,术中是否保留左结肠动脉,吻合口距肛缘距离,是否行预防性造口,术后吻合口漏,还纳造口时间,肿瘤大小,肿瘤TNM分期,肿瘤分化程度。将单因素分析中P<0.05的因素进行多因素Logistic回归分析,以P<0.05认为差异具有统计学意义。结果:本研究中直肠前切除综合征的发生率为49.16%(88/179),88例LARS患者中经6个月、12个月恢复时间,好转例数分别为36例(40.91%)、64例(72.73%)。回顾性分析术前相关因素:性别、年龄、体重指数BMI,术前是否有合并疾病,术前是否行新辅助治疗;手术相关因素:手术时间,术中出血量,术中是否保留左结肠动脉,吻合口距肛缘距离,是否行预防性造口;术后相关因素:术后吻合口漏,还纳造口时间;肿瘤相关因素:肿瘤大小,肿瘤TNM分期,肿瘤分化程度。经单因素分析及多因素Logistic回归分析得出:术前行新辅助治疗,术中完全结扎左结肠动脉;吻合口距肛缘<5cm;术后吻合口漏是直肠前切除综合征LARS发生的危险因素。结论:直肠癌保肛手术后直肠前切除综合征并非单一因素诱发,而是多种因素影响的结果。本次研究显示:术前新辅助治疗,术中完全结扎左结肠动脉,术后吻合口漏,吻合口距肛缘<5cm,是LARS发生的危险因素。直肠前综合征是一种严重影响患者生活质量的术后并发症,结合发病的相关危险因素,为临床医生提供参考,以减少LARS的发生,同时提醒临床医生在进行直肠癌手术保留肛门的同时,应同时注重功能的保护。更多还原

【Abstract】 Objective:Anterior resection syndrome after rectal cancer surgery is a high complication rate after anus-preserving surgery for rectal cancer,which has an impact on the quality of life and psychology of patients.In this study,the risk factors of anterior rectotomy syndrome were analyzed retrospectively to provide references for clinical doctors in order to reduce the incidence of postoperative anterior rectotomy syndrome.Method:A retrospective analysis was performed on 179 patients with anus-preserving surgery for rectal cancer included in this study,91 patients without anterior rectotomy syndrome were included in the control group,88 patients with anterior rectotomy syndrome were included in the study group.In combination with relevant data,the following factors were collected and analyzed: sex,age,body mass index(BMI),pre-operative complications,and pre-operative neoadjuvant therapy,the time of operation,the amount of blood lost during the operation,whether the left colonic artery was preserved,the distance between the anastomotic site and the anal border,whether a prophylactic stoma was performed,the anastomotic leakage after operation,the time of closing the stoma,the size of the tumor,the staging of the tumor,and the degree of differentiation.The factors of P < 0.05 in univariate analysis were analyzed by multiple Logistic regression,and the difference was statistically significant in P < 0.05.Result:In this study,the incidence of anterior rectotomy syndrome was 49.16%(88/179).Among 88 LARS patients,the recovery time was 6 months and 12 months,and the number of cases of improvement was 36 and 64.Retrospective analysis of preoperative factors: sex,age,body mass index(BMI),preoperative complications,preoperative whether new adjuvant treatment;Surgical related factors: operation time,intraoperative bleeding,whether to retain the left colonic artery,anastomotic distance from the anal margin,whether to carry out preventive stoma;Postoperative related factors: postoperative anastomotic leakage,including stoma time;tumor related factors: tumor size,tumor TNM stage,degree of differentiation.The results of univariate analysis and multivariate Logistic regression analysis showed that: Preoperative neoadjuvant therapy was performed and,the left colonic artery was completely ligation.Anastomosis distance from anal margin < 5cm;Postoperative anastomotic leakage is the risk factor for LARS of anterior rectal resection syndrome.Conclusion:Anterior rectal resection syndrome after anus-preserving surgery for rectal cancer is not caused by a single factor,but by a combination of factors.This study showed that preoperative neoadjuvant therapy,complete intraoperative ligation of the left colonic artery,and postoperative anastomotic leakage,less than 5cm from the anal margin were risk factors for LARS.Anterior rectal syndrome is a serious postoperative complication that affects the quality of life of patients.In view of the related risk factors,the clinician should pay attention to the functional protection while preserving the anus.更多还原