直肠癌经肛全直肠系膜切除术后生活质量变化及低位前切除综合征发生风险分析

Quality of Life and Risk Factors of Low Anterior Resection Syndrome After Transanal Total Mesorectal Excision in Patients with Rectal Cancer

[目的]探讨直肠癌经肛全直肠系膜切除(transanal total mesorectal excision,taTME)术后患者生活质量变化及低位前切除综合征(low anterior resection syndrome,LARS)发生风险的影响因素。[方法]回顾性分析84例行taTME术治疗直肠癌患者的临床资料,比较手术前后EORTC评分、泌尿功能变化情况、LARS发生情况及LARS相关症状发生情况,采用单因素和多因素分析直肠癌taTME术后LARS发生风险的影响因素。[结果]术后1个月,患者躯体功能评分、角色功能评分、疼痛评分以及总体健康状况评分均显著低于术前(P均<0.05);术后6个月,患者角色功能评分显著低于术前(P<0.05)。手术前后,患者轻度、中重度排尿功能障碍发生率及轻度LARS发生率差异无统计学意义(P>0.05);术后1个月、6个月无LARS比例显著低于术前(P<0.05);术后1个月、6个月重度LARS发生率显著高于术前(P<0.05)。患者术后1个月肛门排气失禁发生率显著高于术前和术后6个月(P<0.05);术后6个月肛门排气失禁发生率显著高于术前(P<0.05);术后1个月和6个月液体排便失禁、排便次数异常、排粪聚集及急迫发生率均显著高于术前(P<0.05)。单因素分析结果显示,经肛门手术时间与直肠癌taTME术后LARS发生风险有关(P<0.05);多因素Logistic回归模型分析结果显示,经肛门手术时间不是直肠癌taTME术后LARS发生风险的独立影响因素(OR=1.10,95%CI:0.78~1.96,P=0.27)。[结论]直肠癌taTME术后早期生活质量明显降低,但随时间延长明显改善;术后LARS具有发生率高和短期无法缓解的特点。

[Objective]To analyze the quality of life and risk factors of low anterior resection syndrome(LARS)after transanal total mesorectal excision(taTME)in patients with rectal cancer.[Methods]Clinical data of 84 patients with rectal cancer treated with taTME were retrospectively analyzed.The EORTC score,urinary function changes,LARS and LARS related symptoms were compared before and after surgical treatment.Univariate and multivariate regression analyses were used to evaluate the risk factors of LARS after taTME for rectal cancer.[Results]The scores of body function,role function,pain and overall health status 1 month after operation were significantly lower than those before operation(all P<0.05).The role function score 6 months after operation was significantly lower than that before operation(P<0.05).There was no significant difference in the incidence of mild,moderate and severe urinary dysfunction and mild LARS before and after operation(P>0.05).The proportion of patients without LARS at 1 month and 6 months after operation was significantly lower than that before operation(P<0.05).The incidence of severe LARS at 1 month and 6 months after operation was significantly higher than that before operation(P<0.05).The incidence of anal exhaust incontinence in 1 month after operation was significantly higher than that before operation and 6 months after operation(P<0.05).The incidence of anal exhaust incontinence at 6 months after operation was significantly higher than that before operation(P<0.05).The incidence of liquid fecal incontinence,abnormal defecation times,fecal aggregation and urgency at 1 month and 6 months after operation was significantly higher than that before operation(P<0.05).Univariate analysis showed that transanal operation time was related to the risk of LARS after taTME in patients with rectal cancer(P<0.05).Multivariate Logistic regression analysis showed that the time of transanal operation was not an independent risk factor of LARS after taTME in patients with rectal cancer(OR=1.10,95%C:0.78~1.96,P=0.27).[Conclusion]The quality of life decreased significantly in the early stage after taTME for patients with rectal cancer,but it would be improved significantly gradually;the incidence of postoperative LARS is high and it can not be alleviated in short term.