腹腔镜直肠癌术后预防性造口患者生活质量及低位前切除综合征症状的严重程度分析

Analysis of quality of life and severity of symptoms of low anterior resection syndrome in patients with preventive stoma after laparoscopic rectal cancer surgery

目的探讨腹腔镜直肠癌术后预防性造口患者生活质量的变化,并分析其低位前切除综合征(LARS)的严重程度。方法回顾性纳入2018年7月至2020年7月海南省东部中心医院收治的腹腔镜直肠癌术患者120例。根据其是否行预防性造口,分成造口组(n=68)、非造口组(n=52)。记录2组患者腹腔镜围手术期指标,随访6个月,利用简明生活质量量表(SF-36)评估患者术后1、6个月生活质量的变化,经LARS评分量表对患者LARS发生率以及严重程度进行评估。采用Logistic回归模型分析预防性造口患者重度LARS发生的危险因素。结果 2组患者手术时间、术中出血量、首次排气时间、术后住院时间比较,差异无统计学意义(P> 0.05)。2组患者术后6个月的心理健康、躯体疼痛、躯体角色功能、躯体功能、精力、社会功能、情绪角色功能、总体健康评分高于术后1个月,且造口组心理健康、躯体疼痛、躯体角色功能、躯体功能、情绪角色功能、总体健康评分为(65.95±7.58)、(62.01±6.04)、(64.93±7.91)、(64.12±6.45)、(63.41±7.13)、(64.62±5.14)分,高于非造口组[(60.49±5.96)、(57.24±5.72)、(58.45±6.68)、(60.43±5.05)、(58.53±6.48)、(60.42±6.31)分],差异有统计学意义(P <0.05)。造口组轻度LARS发生率高于非造口组(57.35%vs. 38.46%),重度LARS发生率低于非造口组(22.06%vs. 40.38%),差异有统计学意义(P <0.05)。Logistic多因素分析显示,肿瘤距肛缘距离<5 cm、低位肿瘤、吻合口瘘是预防性造口患者重度LARS发生的危险因素(P <0.05)。结论预防性造口能提升腹腔镜直肠癌术患者的生活质量,且能降低重度LARS发生率,预防性造口患者重度LARS发生主要与肿瘤距肛缘距离、肿瘤位置、吻合口瘘有关。

Objective To explore the quality of life of patients with preventive stoma after laparoscopic rectal cancer surgery,and analyze the severity of low anterior resection syndrome(LARS). Methods A total of 120 patients undergoing laparoscopic rectal cancer surgery in Eastern Central Hospital of Hainan Province from July 2018 to July 2020 were included. The clinical data of the patients were retrospectively analyzed,and the patients were divided into stoma groups according to whether they performed a preventive stoma(n = 68),non-stoma group(n = 52).The medical outcomes study 36-item short-form(SF-36) was used to evaluate the changes in the quality of life of the patients at 1 and 6 months after the operation. The incidence and severity of LARS were evaluated using the LARS score scale,and the Logistic regression model was used to analyze the risk factors of severe LARS in preventive stoma patients. Results There was no difference in operation time,intraoperative blood loss,first exhaust time,and postoperative hospital stay between the two groups(P > 0. 05). The mental health,physical pain,physical role function,physical function,energy,social function,emotional role function,and overall health scores of the two groups at 6 months after surgery were higher than those of the 1 month after surgery. And the mental health and physical pain,the scores of physical role function,physical function,emotional role function,and overall health score of the stoma group were(65. 95 ± 7. 58),(62. 01 ± 6. 04),(64. 93 ± 7. 91),(64. 12± 6. 45),(63. 41 ± 7. 13),(64. 62 ± 5. 14) points,which were higher than those of the non-stoma group[(60. 49 ± 5. 96),(57. 24 ± 5. 72),(58. 45 ± 6. 68),(60. 43 ± 5. 05),(58. 53 ± 6. 48),(60. 42 ± 6. 31) points],the differences were statistically significant(P < 0. 05). The incidence of mild LARS in the stoma group was higher than that in the non-stoma group(57. 35% vs. 38. 46%),and the incidence of severe LARS was lower than that in the non-stoma group(22. 06% vs. 40. 38%),The difference was statistically significant(P < 0. 05). Logistic multivariate analysis showed that the distance between the tumor and the anal margin was less than 5 cm,low tumors,and anastomotic leakage were risk factors for the occurrence of severe LARS in preventive stoma patients(P < 0. 05). Conclusion Preventive stoma can improve the quality of life of patients undergoing laparoscopic rectal cancer surgery,and can reduce the incidence of severe LARS. The occurrence of severe LARS in preventive stoma patients is mainly related to the distance of the tumor from the anal margin,tumor location,and anastomotic leakage.