经括约肌间切除术后直肠低位前切除综合征的诊断与治疗策略

Diagnosis and treatment of low anterior resection syndrome after intersphincteric resection for low rectal cancer

经括约肌间切除术(ISR)是低位直肠癌的极限保肛手术.已有较多的循证医学数据表明,ISR可使部分低位直肠癌患者在保证肿瘤学疗效的基础上,免遭切除肛门的痛苦.然而,由于该手术在切除直肠的同时需切除部分或全部肛门内括约肌,吻合口位置极低,术后部分患者容易出现直肠低位前切除综合征(LARS),表现为肛门失禁、便次增多、急迫感、排便不尽、排空障碍等.笔者回顾既往研究成果,结合团队经验,探讨ISR后LARS的诊断与治疗策略.

Intersphincteric resection(ISR)is an advanced sphincter-preserving surgery for low rectal cancer.Accumulating evidences from clinical studies indicate that ISR can spare some pati-ents with low rectal cancer from the distress of anal amputation while ensuring oncological efficacy.However,due to the necessity of removing part or all of the internal sphincter during rectal resection and the extremely low anastomosis level,a subset of patients may experience low anterior resection syndrome(LARS)after surgery.LARS is characterized by symptoms such as anal incontinence,increased bowel frequency,urgency,incomplete evacuation,and obstructed defecation.Based on relevant literature and team practice,the authors provide an overview of the diagnosis and treat-ment progress of LARS following ISR.