直肠癌患者发生低位前切除综合征的相关危险因素

Multivariate analysis of low anterior resection syndrome of 230 postoperative patients with rectal cancer

摘要:

目的 分析230 例直肠癌患者术后排便功能变化，探索直肠癌保肛手术后患者发生低位前切除综 合征（LARS）的相关危险因素。方法 选取2013 年1 月—2017 年12 月在山西省人民医院行直肠癌低位前 切除手术，术中遵循直肠全系膜切除术原则的患者。按手术时间顺序采用电话、当面随访等方式对研究对象 的排便功能进行评估。根据患者LARS 严重程度，分为有LARS 组（轻度及以上症状）和无LARS 组，比较 两组患者临床资料的差异，探究发生LARS 的危险因素。结果 230 例患者，有LARS 组患者126 例（54.8%）， 无LARS 组患者104 例（45.2%）。两组患者性别、N 分期、肿瘤位置、预防性回肠造瘘及有无吻合口漏比 较，经χ2 检验，差异有统计学意义（P <0.05）。多因素Logistic 回归分析显示，女性[Ol ^ R=2.301，95% CI （1.239,4.275）]、低位肿瘤[Ol ^ R=0.410，95% CI（0.288，0.584）] 及吻合口漏[Ol ^ R=29.289，95% CI（1.045， 82.533）] 是直肠癌患者术后LARS 评分的独立影响因素（P <0.05）。结论 直肠癌患者术后LARS 发生率 高，N 分期、预防性回肠造瘘对直肠癌患者术后LARS 有影响；而女性、低位肿瘤和吻合口漏是其独立危险 因素。

Abstract:

Objective To analyze the postoperative defecation function in 230 cases of rectal cancer, and study the risk factors of the low anterior resection syndrome (LARS). Methods Totally 230 cases of low rectal cancer who underwent the low anterior resection in Shanxi Provincial People’s Hospital during from January 2013 to December 2017 were selected ,and all of them followed the TME principle. During this period, telephone follow-up, face-to-face follow-up and other methods were used for evaluating the defecation function of the subjects. Based on the severity of the patient of LARS, we tried to find out the difference of several clinical factors between the group of above lowgrade LARS and the group of asymptomatic LARS. Results Out of 230 patients, patients with above low-grade LARS for 126 cases (54.8%), and 104 patients with asymptomatic LARS (45.2%). The difference in sexes, N stage, tumor location, preventive colostomy and the presence of anastomotic leakage was statistically significant (P < 0.05).Multivariate analysis show that female [Ol ^ R=2.301, 95% CI (1.239, 4.275)], low tumor location [Ol ^ R=0.410, 95% CI (0.288, 0.584)] and anastomotic leakage [Ol ^ R=29.289, 95% CI (1.045, 82.533)] were risk factors of LARS (P < 0.05). Conclusions The incidence of the LARS in postoperative patients with rectal cancer is high. The severity of the LARS is affected by N stage and preventive colostomy. The female, low tumor and anastomotic leakage are independent risk factors.