重度LARS的影响因素分析

Factors predicting the occurrence of severe low anterior resection syndrome

目的探讨低位直肠癌前切除术后发生重度低位前切除综合征(LARS)的影响因素。方法回顾性分析2015年10月至2018年10月青岛市第八人民医院和青岛市立医院收治的107例低位直肠癌患者的临床资料,采用单因素分析和多因素Logistic回归分析探讨发生重度LARS的影响因素。结果107例患者中,术后88例(82.2%)发生LARS,其中轻度LARS 47例(43.9%),重度LARS 41例(38.3%)。单因素分析结果提示肿瘤直径(≥5 cm)、TNM分期(Ⅲ~Ⅳ期)、发生吻合口漏、吻合口距肛缘距离(≤5 cm)、新辅助放疗、非全程保留自主神经(TANP)均与重度LARS有关(均P<0.05);多因素Logistic回归分析结果显示,吻合口距肛缘距离≤5 cm、发生吻合口漏、新辅助放疗是低位直肠癌前切除术后发生重度LARS的独立危险因素,而TANP是独立保护因素(均P<0.05)。结论重度LARS的发生与吻合口距肛缘距离过短、发生吻合口漏及新辅助放疗有关,而TANP是预防LARS发生的独立保护因素。临床医师应对以上因素予以重视,减少重度LARS的发生。

Objectives To investigate the factors that predict the occurrence of severe low anterior resection syndrome(LARS)after anterior resection for low rectal cancer.Methods This was a retrospective analysis of clinical data of 107 patients with low rectal cancer treated at the Qingdao No.8 People’s Hospital and Qingdao Municipal Hospital between October 2015 and Oc⁃tober 2018.Univariate and multivariate Logistic regression was used to analyze the factors predicting the occurrence of severe LARS.Results Of the 107 patients,88(82.2%)had LARS,among which 47(43.9%)were mild LARS,and 41(38.3%)were se⁃vere LARS.Univariate analysis showed that the occurrence of severe LARS was associated with tumor diameter(≥5 cm),TNM stage(Ⅲ~Ⅳstage),anastomotic leak,the distance between anastomosis and anal edge(≤5 cm),neoadjuvant radiotherapy,and not total autonomic nerve preservation(TANP)(P<0.05).Multivariate logistic regression showed that the independent risk factors for severe LARS were the distance between anastomosis and anal edge(≤5 cm),anastomotic leak,and nonadjunctive radiotherapy,while TANP was an independent protective factor(P<0.05).Conclusion The occurrence of severe LARS is associated with short distance between anastomosis and anal edge,anastomotic leak,and neoadjuvant radiotherapy.TANP procedure is an independent protective factor for severe LARS.Clinicians should pay attention to the above factors to reduce the occurrence of severe LARS.