外科手术治疗方案对左半结肠癌伴急性完全梗阻患者术后早期肛门功能的影响研究

Influence of surgical treatment on early postoperative anal function in left colon cancer patients with acute complete obstruction

目的 探讨外科手术治疗方案对左半结肠癌伴急性完全梗阻患者术后早期肛门功能的影响。方法 回顾性分析2017年1月至2020年6月期间于宜宾市第二人民医院行手术治疗的144例左半结肠癌伴急性完全梗阻患者的临床资料,根据治疗方案分为急诊手术组(54例)、支架+手术组(46例)及支架+新辅助化疗(neoadjuvant chemotherapy,NAC)+手术组(44例)。分别于术后第4周、第1个月和第6个月调查患者的肛门功能,于术后第12个月调查生命质量。采用非条件logistic回归模型探索术后早期肛门功能损伤的影响因素。结果 急诊手术组的开腹手术比例高于支架+手术组和支架+NAC+手术组(P<0.05);术后第4周急诊手术组的低位直肠前切除综合征(low anterior rectum resection syndrome,LARS)量表评分高于支架+手术组和支架+NAC+手术组(P<0.05),但术后第1个月和第6个月时3组的LARS量表评分比较差异无统计学意义(P>0.05);术后第12个月急诊手术组的社会功能评分低于支架+手术组和支架+NAC+手术组(P<0.05)。多因素logistic回归分析结果显示,体质量指数(body mass index,BMI)≥24 kg/m^(2)、急诊手术和东部肿瘤协作组评分1分是左半结肠癌伴完全梗阻患者术后早期肛门功能损伤的危险因素(P<0.05)。结论 BMI≥24 kg/m^(2)和单纯接受急诊手术治疗左半结肠癌伴急性完全梗阻的患者术后更易出现肛门功能损伤,且单纯接受急诊手术者的生活质量下降,通过梗阻部位支架置入则有助于避免上述问题发生。

Objective To investigate the influence of surgical treatment on early postoperative anal function in left colon cancer patients with acute complete obstruction.Methods The clinical data of left colon cancer patients with acute complete obstruction were retrospectively chosen from January 2017 to June 2020 in Yibin Second People's Hospital.The patients were grouped according to the treatment plan including emergency operation group(54 cases),stent+operation group(46 cases)and stent+neoadjuvant chemotherapy(NAC)+operation group(44 cases).The anal function was evaluated at 4 weeks,1 month and 6 months after operation,and quality of life was evaluated at 12months after operation.Unconditional logistic regression model was used to explore the factors influencing early postoperative anal function injury.Results The proportion of open surgery in the emergency operation group was statistically higher than the stent+operation group and stent+NAC+operation group(P0.05).The low anterior rectum resection syndrome(LARS)score at 4 weeks after operation of the emergency operation group was statistically higher than those of the stent+operation group and stent+NAC+operation group(P0.05).However there was no statistical difference in LARS score at 1 month and 6 months after operation among the three groups(P0.05).The score of social function in the emergency operation group at 12 months after operation was statistically lower than those of the stent+operation group and stent+NAC+operation group(P0.05).Multivariate logistic regression analysis showed that body mass index(BMI)≥24 kg/m~2,emergency operation,and Eastern Collaborative Oncology Group(ECOG)score were the risk factors for early postoperative anal dysfunction in the left colon cancer patients with acute complete obstruction(P0.05).Conclusions Left colon cancer patients complicated with acute complete obstruction who only received emergency surgery,BMI≥24 kg/m~2,or one score of ECOG are more likely to have functional impairment,and the quality of life of those patients underwent emergency surgery alone is decreased.In addition,the stent placement at the obstruction site should be helpful to avoid the above problems.