直肠癌低位前切除综合征预防及管理的证据总结

Evidence summary for prevention and management of low anterior resection syndrome of rectal cancer

目的检索、评价并总结直肠癌术后低位前切除综合征(low anterior resection syndrome,LARS)预防及管理的证据,为临床医护人员提供循证参考依据。方法计算机检索Up To Date、BMJ Best Practice、英国国家临床医学研究所(National Institute for Health and Care Excellence,NICE)指南库、加拿大安大略护理学会网站(Registered Nurses’Association of Ontario,RNAO)、苏格兰院际间指南网(Scottish Intercollegiate Guidelines Network,SIGN)、医脉通、澳大利亚JBI循证卫生保健中心数据库、Cochrane Library、大不列颠及爱尔兰肛肠协会网站(Association of Coloproctology of Great Britain and Ireland,ACPGBI)、美国结直肠外科医生协会网站(American Society of Colon and Rectal Surgeons,ASCRS)、英国胃肠病学会网站(British Society of Gastroenterology,BSG)、PubMed、Embase、中国知网和万方数据库中关于LARS预防及管理的文献,检索时限为建库至2021年8月。由2名研究者采用澳大利亚JBI循证卫生保健中心等的文献评价标准和证据分级系统,对所纳入的文献进行质量评价及证据级别评定。结果共纳入16篇文献,包括临床决策1篇、指南6篇、专家共识2篇、系统评价6篇、分析性横断面研究1篇,最终总结出关于LARS的评估、预防、药物控制、多模式治疗和居家自护与观察5个方面的17条证据。结论本研究总结了LARS的预防及管理的证据,为临床医护人员的实践提供循证参考依据。

Objective To investigate and evaluate the evidences in relation to prevention and management of low anterior resection syndrome(LARS)after the surgeries for rectal cancer so as to provide an evidence-based reference for clinical staff.Methods Evidences in prevention and management of LARS were searched through databases of Up To Date,BMJ Best Practice,National Institute for Health and Care Excellence,Registered Nurses’Association of Ontario,Scottish Intercollegiate Guidelines Network,Medlive,Australian JBI Evidence-Based Health Care Centre Database,Cochrane Library,Association of Coloproctology of Great Britain and Ireland,American Society of Colon and Rectal Surgeons,the British Society of Gastroenterology,PubMed,Embase,CNKI and Wanfang Data from the inception of the databases up to August 2021.Two researchers used the literature evaluation standards of Australian JBI Evidence-based Health Care Centre and the evidence grading system to evaluate the quality and evidence grading for the included literatures.Evidences were extracted from the literatures that met the quality standards and then the evidences were summarised.Results A total of 16 papers were included covering 1 clinical decision,6 guidelines,2 expert consensuses,6 systematic reviews and 1 analytical cross-sectional study.In total,17 pieces of evidences of LARS were summarised,including assessment,prevention,drug control,multimodal therapy,home self-care and observation.Conclusion In this study,the evidences for LARS prevention and management are summarised in order to provide an evidence-based reference for clinical practice of the medical staff.