腹腔镜辅助经肛全直肠系膜切除术的低位直肠癌患者术后排便功能研究

Study on defecation function in patients with low rectal cancer after laparoscopic assisted transanal total mesorectal excision

  • 摘要: 目的 分析低位直肠癌患者行腹腔镜辅助经肛全直肠系膜切除术(TaTME)对术后排便功能的影响因素。 方法 收集本院收治的87例行TaTME术的低位直肠癌患者的临床资料,采用低位前切除综合征(LARS)量表评估患者术后3个月的排便功能,并根据排便功能情况分为LARS组(评分≥21分, 42例)及无LARS组(评分≤20分,45例)。设计一般情况调查问卷,采用单因素与多因素分析找出低位直肠癌患者TaTME术后排便功能的影响因素。 结果 多项非条件Logistic回归分析检验结果显示,吻合口距肛缘<2 cm、肛门括约肌损伤、肿瘤与肛缘之间距离<5 cm、新辅助放化疗均可能是低位直肠癌患者行TaTME术后排便功能的影响因素(OR>1, P<0.05)。 结论 低位直肠癌患者TaTME术后排便功能受多种因素影响,其中吻合口距肛缘距离、肛门括约肌损伤、肿瘤与肛缘之间的距离、新辅助放化疗是主要影响因素,因此临床需重点关注并给予患者相应干预措施。

     

    Abstract: Objective To analyze the influencing factors of defecation function in patients with low rectal cancer after laparoscopic assisted transanal total mesorectal excision(TaTME). Methods The clinical data of 87 low rectal cancer patients with TaTME in our hospital was collected and was retrospectively analyzed. The postoperative 3-month defecation function was evaluated by Low Anterior Resection Syndrome(LARS)Scale. The patients were divided into LARS group(scored≥21, n=42)and LARS-free group(scored≤20, n=45)according to their defecation functions. The general situation questionnaire was designed, and the univariate and multivariate analysis were used to identify the influencing factors of defecation function in patients with low rectal cancer after TaTME. Results The results of multiple non-conditional Logistic regression analysis showed that the distance between anastomosis and anal margin smaller than 2 cm, anal sphincter injury, distance between tumor and anal margin below 5 cm, and neoadjuvant chemoradiotherapy may be the influencing factors of defecation function in patients with low rectal cancer after TaTME(OR>1, P<0.05). Conclusion The defecation function of patients with low rectal cancer after TaTME is affected by varied factors, among which the distance between anastomosis and anal margin, anal sphincter injury, distance between tumor and anal margin, and neoadjuvant chemoradiotherapy are the main influencing factors. Therefore, close focus on these factors should be done and corresponding intervention measures should be given to these patents in clinic.

     

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