GSRS评分改良分级系统在评估结肠癌患者发生术后长期胃肠功能紊乱中的临床应用

Clinical application of modified grading system for GSRS scores in assessing long-term postoperative gastrointestinal dysfunction in colon cancer patients

目的初步探讨胃肠道症状评定量表(GSRS)评分改良分级系统在结肠癌患者长期术后胃肠功能紊乱(PGID)评估中的实际应用及其临床意义。方法回顾性分析2021年9月—2022年9月于首都医科大学附属北京友谊医院接受右半结肠癌根治术的122例患者的病例资料,其中男性69例(56.6%),女性53例(43.4%);中位年龄为66.5岁;体重指数为(24.4±3.3)kg/m^(2)。主要观察指标为患者GSRS评分。正态分布的计量资料以均数±标准差(±s)表示,组间比较采用方差分析;非正态分布的计量资料以中位数(四分位间距)[M(Q_(1),Q_(3))]表示,组间比较采用Kruskal-WallisH检验。无序计数资料组间比较采用χ^(2)检验,有序计数资料组间比较采用Kruskal-WallisH检验。GSRS评分使用密度图表示,评分分为5个症状群,采用雷达图表示各症状群的分布情况。结果122例患者中最常见的长期PGID症候群为消化不良,其次是腹痛、腹泻和便秘。受试者群体中的GSRS评分数据显示出一种近乎三峰的趋势。基于数据的整体趋势,对GSRS评分进行分级改良,以20分和30分为截断值,将右半结肠癌患者分为低危、中危和高危三组,用于量化患者长期PGID的严重程度。结果显示,在性别分布方面,三组之间差异具有统计学意义(P=0.031),男性可能更容易出现长期PGID;然而,在年龄、肿瘤位置、手术方式、吻合方式、淋巴结清扫、病理分期、辅助化疗等因素方面,三组之间差异均无统计学意义(P>0.05)。结论GSRS评分的改良分级系统符合结肠癌患者术后胃肠功能的分布特征,可量化术后患者发生PGID的风险,以便将术后患者进行分级管理,改善患者术后生活质量。

Objective To explore the practical application and clinical significance of modified grading system for Gastrointestinal Symptom Rating Scale(GSRS))scores in evaluating long-term postoperative gastrointestinal dysfunction(PGID)in patients after colon cancer surgery.Methods A retrospective analysis was conducted on the case data of 122 patients who underwent right hemicolectomy for colorectal cancer at Beijing Friendship Hospital,Capital Medical University from September 2021 to September 2022.Among these patients,69 were males(56.6%),and 53 were females(43.4%).The median age was 66.5 years,and the body mass index was(24.4±3.3)kg/m^(2).The main observe indiator was GSRS scores of patients.The measurement data of normal distribution were represented as mean standard deviation(x±s),and intergroup comparisons were conducted using ANOVA.The measurement data of non-normal distribution were expressed as the median(interquartile distance)[M(Q_(1),Q_(3))],the Kruskal-Wallis H test was employed.Unordered count data comparisons were performed using the x test,while comparisons for ordered count data between groups were conducted using the Kruskal-Wallis H test.CSRS scores were represented using density plots,and the scores were categorized into five symptom groups,presented using radar charts to illustrate the distribution of each symptom group.Results Among the 122 patients,the most common long-term PGID syndromes was dyspepsia,followed by abdominal pain,diarrhea,and constipation.GSRS score data in the study population exhibited a nearly trimodal trend.Based on the overall data trend,the GSRS scale was refined,with cut-off values of 20 and 30,categorizing patients with right-sided colon cancer into low-risk,moderate-risk,and high-risk groups for quantifying the severity of long-term PCID.In terms of gender distribution,the differences among the three groups was statistically significant(P=0.031),suggesting that males may be more susceptible to long-term PGID.However,there were no significant differences among the three groups concerning age,tumor location,surgical approach,anastomotic technique,lymph node dissection,pathological staging,adjuvant chemotherapy,and other factors.Conclusions The modified grading system for GSRS scores aligns with the distribution characteristics of postoperative gastrointestinal function in colorectal cancer patients.It can quantify the risk of long-term PCID,allowing for a graded management approach to improve the postoperative quality of life for patients.