腹腔镜辅助经肛全系膜切除术后低位前切除综合征的发生及影响因素相关研究

Occurrence and influencing factors of low anterior resection syndrome after peritoneoscopically assisted transanal total mesangectomy

摘要:

目的 探讨分析腹腔镜辅助经肛全系膜切除术（TaTME）后低位前切除综合征的发生及影响因素，为今后改善TaTME治疗直肠癌患者的排便功能提供依据。方法 选取2019年1月至2023年1月惠州市中心人民医院胃肠外科收治的62例行腹腔镜TaTME中低位直肠癌患者，术后3个月、6个月依据直肠癌低位前切除综合征（LARS）量表评分分为LARS组和FLARS组，分别分析术后3个月、6个月发生LARS的影响因素（单因素、多因素回归分析）。结果 术后3个月LARS发生率为66.13%，显著高于术后6个月（41.94%）（P<0.05）。术后3个月单因素和多因素分析均显示：LARS发生的独立危险因素为肿瘤直径、术前放化疗率及吻合口距肛缘距离；术后6个月单因素和多因素分析均显示：LARS发生的独立危险因素为术前放化疗率、吻合口距肛缘距离。结论 TaTME治疗中低位直肠癌患者，术后3个月LARS发生率显著高于术后6个月，患者术后康复训练和疾病恢复密切相关，TaTME术后发生LARS的独立危险因素为同步放化疗、术后吻合口距肛缘距离（<2 cm）、肿瘤直径（≥5 cm），在手术过程需要引起注意，加以干预，降低术后LARS发生率，改善患者排便功能。

关键词:腹腔镜辅助经肛全系膜切除术;低位前切除综合征;中低位直肠癌;影响因素

Abstract:

Objective To investigate the occurrence and influencing factors of low anterior resection syndrome after peritoneoscopically assisted transanal total mesorectal excision (TaTME), and to provide evidence for improving defecation function in rectal cancer patients treated with TaTME in the future.Methods Sixty-two patients treated with laparoscopic TaTME for middle and low rectal cancer admitted to the Gastrointestinal Surgery Department of Huizhou Central People's Hospital from January 2019 to January 2023 were selected and divided into low anterior resection syndrome (LARS) group and FLARS group according to LARS scale score 3 months and 6 months after surgery. The influencing factors of LARS at 3 and 6 months after operation were analyzed respectively (univariate and multivariate regression analysis).Results The incidence of LARS at 3 months after surgery was 66.13%, which was significantly higher than that at 6 months after surgery (41.94%) (P<0.05). Univariate and multivariate analysis at 3 months after surgery showed that the independent risk factors for LARS were tumor diameter, preoperative rate of radiotherapy and chemotherapy and the distance from the anastomosis to the anal margin. Univariate and multivariate analysis at 6 months after surgery showed that the independent risk factors for LARS were the rate of preoperative chemoradiation and the distance between anastomosis and anal margin.Conclusion The incidence of LARS 3 months after laparoscopic-assisted TaTME in the treatment of low and middle rectal cancer patients was significantly higher than that 6 months after surgery, which was closely related to postoperative rehabilitation training and disease recovery. The independent risk factors for LARS after TaTME surgery are synchronous chemoradiation, postoperative distance from the anastomosis to the anal margin (<2 cm), and tumor diameter (≥5 cm). Attention and intervention should be paid during surgery to reduce the incidence of LARS after surgery and improve the defecation function of patients.

Key words:laparoscope-assisted transanal total mesorectal excision;low anterior resection syndrome;middle and low rectal cancer;influencing factors