中华肿瘤防治杂志2024，Vol.31Issue(1) ：33-38.DOI:10.16073/j.cnki.cjcpt.2024.01.05

直肠癌保肛术后患者发生低位前切除综合征及对肠道功能和生活质量影响的研究

Current status of the occurrence of low anterior resection syndrome,bowel function and quality of life in patients after rectal cancer conserving surgery

木尼瓦尔·买买提 蔡晓慧 刘娟 刘瑶 王丽君 葛磊
中华肿瘤防治杂志2024，Vol.31Issue(1) ：33-38.DOI:10.16073/j.cnki.cjcpt.2024.01.05
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直肠癌保肛术后患者发生低位前切除综合征及对肠道功能和生活质量影响的研究

Current status of the occurrence of low anterior resection syndrome,bowel function and quality of life in patients after rectal cancer conserving surgery

木尼瓦尔·买买提 1蔡晓慧 2刘娟 3刘瑶 1王丽君 3葛磊4
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作者信息

  • 1. 新疆医科大学护理学院,新疆乌鲁木齐 830011
  • 2. 新疆医科大学附属肿瘤医院护理部,新疆乌鲁木齐 830011
  • 3. 新疆医科大学附属肿瘤医院胃肠外科,新疆乌鲁木齐 830011
  • 4. 新疆医科大学附属肿瘤医院胃肠外科,新疆乌鲁木齐 830011;广东医科大学附属医院胃肠外科,广东湛江 524001
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摘要

目的 探讨直肠癌保肛术后长期生存患者低位前切除综合征(LARS)发生情况,并调查对患者肠道功能和生活质量的影响.方法 收集2010-01-01-2018-04-10在新疆医科大学附属肿瘤医院接受直肠癌保肛根治术并生存≥5年的135例患者临床资料,其中61例发生LARS(LARS组),74例未发生LARS(无LARS组).无LARS组年龄为49.5(19.0～68.0)岁,LARS组为53.0(29.0～68.0)岁.采用单中心回顾性横断面研究方法,对入组的患者采用电话访谈的方式用量表进行调查,并分析这些患者LARS的发生情况、肠道功能及生活质量.对可能与LARS评分升高的相关因素根据变量类型进行单因素分析,分类变量采用x2检验,不符合正态分布的变量用Mann-Whitney U检验;二元logistic回归分析LARS的危险因素.结果 单因素分析发现,肿瘤距肛缘距离和术后时间是影响肠道功能的危险因素(t=3.510,P=0.033;t=4.350,P=0.015).对肿瘤距肛缘距离和术后时间行多元线性回归分析显示,肿瘤距肛缘＞10和＜5 cm者肠道功能的差异有统计学意义,P＜0.05;术后5～7年和＞10年患者肠道功能的差异有统计学意义,P＜0.05.二元logistic回归分析显示,术前放疗和肿瘤距肛缘距离是影响LARS发生的高危因素(P=0.036;P=0.017),而术后时间在术后LARS发生风险的多因素分析中差异无统计学意义,P=0.109.生活质量得分中,躯体形象、便频、臀痛、肛门排气和排便尴尬的差异有统计学意义,均P＜0.05.结论 术前放疗和肿瘤距肛缘距离是影响LARS发生的高危因素,肿瘤距肛缘距离和术后时间是影响肠道功能的危险因素.直肠癌保肛术后长期生存患者仍有较高的LARS患病率,其中无LARS患者的生活质量较LARS者好.

Abstract

Objective To investigate the incidence of low anterior resection syndrome(LARS),and to investigate bowel func-tion and quality of life(QOL)in patients with long-term survival after anorectal cancer preservation surgery.Methods Clinical data were collected from 135 patients who underwent anorectal conservative radical surgery for rectal cancer and survived for ≥5 years at the Cancer Hospital of Xinjiang Medical University from 2010-01-01 to 2018-04-10,among which 61 ca-ses developed LARS(LARS group)and 74 cases did not develop LARS(no LARS group).The age was 49.5(19.0-68.0)years in the no-LARS group and 53.0(29.0-68.0)years in the LARS group.Using a single-center retrospective cross-sectional study method,the enrolled patients were surveyed with a questionnaire using a telephone interview,and the occurrence of LARS,intestinal function,and quality of life were analyzed in these patients.Factors that may be asso-ciated with elevated LARS scores were analyzed by univariate analysis according to the type of variable,with the chi-square test for categorical variables and the Mann-Whitney U test for variables that did not fit a normal distribution;bina-ry logistic regression was used to analyze the risk factors for LARS.Results Univariate analysis revealed that the distance of the tumor from the anal verge and the postoperative time were risk factors for bowel function(t=3.510,P=0.033;t=4.350,P=0.015).Multiple linear regression analysis of the distance of the tumor from the anal verge and postopera-tive time showed that the difference in bowel function between those with a tumor＞10 cm and＜5 cm from the anal verge was statistically significant,P＜0.05;and the difference in bowel function between those with 5-7 years and those with＞10 years postoperatively was statistically significant,P＜0.05.Binary logistic regression analysis showed that preoperative radiotherapy and tumor distance from the anal verge were high-risk factors affecting the occurrence of LARS(P=0.036;P=0.017),whereas postoperative time did not show a statistically significant difference in the multifactorial analysis of the risk of postoperative LARS occurrence in this study,P=0.109.In the quality-of-life scores,the differ-ences in body image,frequency of defecation,buttock pain,anal gas evacuation and defecation embarrassment had statis-tically significant differences,all P＜0.05.Conclusions Preoperative radiotherapy and distance of the tumor from the anal verge are risk factors for the development of LARS,and distance of the tumor from the anal verge and postoperative time are risk factors for the function of the para-intestinal tract.Patients with long-term survival after anal preservation surgery for rectal cancer still have a high prevalence of LARS,in which patients without LARS have better quality of life than those with LARS.

关键词

直肠癌保肛术/低位前切除综合征/长期生存/肠道功能/生活质量

Key words

sphincter-preserving surgery for rectal cancer/low anterior resection syndrome/long-term survival/intestinal function/quality of life

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基金项目

国家自然科学基金(81960434)

新疆自治区自然科学基金(2022D01C296)

出版年

2024
中华肿瘤防治杂志
中华预防医学会 山东省肿瘤防治研究院

中华肿瘤防治杂志

CSTPCD北大核心
影响因子：1.292
ISSN：1673-5269
参考文献量26
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