腹腔镜辅助经肛全直肠系膜切除术后患者低位前切除综合征的发生率及影响因素的Meta分析

The incidence and influencing factors of patients with low anterior resection syndrome after laparoscopic-assisted transanal total mesorectal excision:a Meta-analysis

目的系统评价腹腔镜辅助经肛全直肠系膜切除术(transanal total mesorectal excision,taTME)后患者低位前切除综合征(low anterior resection syndrome,LARS)的发生率及影响因素。方法计算机检索PubMed、Cochrane Library、EmBase、Ovid、EBSCO、Web of Science、中国知网、万方数据库、中国生物医学文献数据库(CBM)、维普数据库等,检索时间为建库至2021年10月。采用RevMan 5.3软件和Stata 12.0分别进行影响因素和发生率的分析。结果本研究最终纳入文献11篇,共730例患者。结果显示,腹腔镜辅助taTME后患者LARS发生率较高,术后12个月最高。腹腔镜辅助taTME后3个月患者LARS发生率为69.8%(P<0.001),术后6~9个月发生率为62.3%(P<0.001),术后12个月发生率为73.8%(P<0.001)。术后6个月轻度LARS发生率为22.5%(P<0.001),重度LARS发生率为45.5%(P<0.001)。Meta分析结果表明,肿瘤T分期、术后吻合口距肛缘距离是腹腔镜辅助taTME后患者LARS发生的危险因素。性别、BMI、肿瘤N分期、吻合方式、同步放化疗可能与腹腔镜辅助taTME后患者发生LARS无关。结论肿瘤T分期中的T_(3)期,术后吻合口距肛缘距离<2 cm是腹腔镜辅助taTME后患者LARS发生的危险因素。早期识别LARS发生高危人群,早期预防LARS的发生,开展LARS综合干预措施,以提高腹腔镜辅助taTME后患者生活质量。

Objective To systematically evaluate the incidence and influencing factors of low anterior resection syndrome(LARS)in patients who underwent laparoscopic-assisted transanal total mesorectal excision(taTME).Methods The data in PubMed,Cochrane Library,EmBase,Ovid,EBSCO,Web of Science,CNKI,WanFang,CBM and VIP Database were searched from the establishment of the database until Oct.2021.The influencing factors and incidence were analysed by RevMan 5.3 software and Stata 12.0.Results A total of 11 studies with 730 patients were included in this study.The incidence of LARS was higher in patients who underwent taTME,with the highest incidence observed at 12 months postoperatively.The incidence rate of LARS in patients who underwent taTME was 69.8% at 3 months(P<0.001),62.3%at 6-9 months(P<0.001),and 73.8% at 12 months(P<0.001)after surgery.The incidence rate of mild LARS at 6 months was 22.5%(P<0.001),and that of severe LARS was 45.5%(P<0.001).The tumor T stage,the distance between the anastomotic site and the anal verge were influencing factors for LARS in patients who underwent taTME.Gender,BMI,tumor N stage,anastomotic technique and synchronous chemoradiotherapy were not related to the occurrence of LARS in patients who underwent taTME.Conclusion Patients with T_(3) stage tumors and a distance<2 cm between the anastomotic site and the anal verge after taTME are at risk for developing LARS.Early identification of high-risk individuals who may develop LARS,early prevention of LARS,and the implementation of comprehensive interventions for LARS can improve the quality of life for patients after taTME.