直肠癌侧方淋巴结清扫术后神经功能状态的影响因素分析

Analysis of influencing factors of neurological function status after lateral lymph node dissection for rectal cancer

目的探讨直肠癌患者行侧方淋巴结清扫术后患者的神经功能状态及其影响因素。方法收集2014年7月至2021年8月于国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院行侧方淋巴结清扫的196例直肠癌患者的临床资料,按照排除标准剔除91例,最终纳入105例。根据侧方淋巴结清扫术后患者的神经功能状态分为神经功能障碍组(n=78)与神经功能正常组(n=27)。比较两组患者的临床病理资料差异,通过单因素与多因素Logistic回归分析探讨侧方淋巴结清扫术后神经功能状态的影响因素。结果105例患者中,27例(25.7%)患者神经功能正常,78例(74.3%)患者出现神经功能障碍,其中38例患者出现排尿功能障碍,62例患者出现性功能障碍,29例患者出现下肢感觉及运动功能障碍。神经功能正常组与神经功能障碍组在性别、年龄、术前新辅助放化疗、肿瘤T分期、有无淋巴结转移、手术方式方面比较差异无统计学意义(P>0.05)。神经功能正常组行筋膜导向侧方淋巴结清扫、单侧侧方淋巴结清扫的患者比例高于神经功能障碍组(P<0.05)。单因素与多因素Logistic回归分析结果显示,以筋膜为导向的侧方淋巴结清扫是患者术后神经功能的保护因素(OR=0.275,95%CI为0.106~0.720,P=0.019)。结论直肠癌侧方淋巴结清扫术后神经功能障碍的发生率较高,以筋膜为导向的侧方淋巴结清扫是患者术后神经功能的保护因素。

Objectives To investigate the status of neurological function and its influencing factors after lateral lymph node dissection(LLND)in patients with rectal cancer.Methods Clinical data were retrospectively collected from 196 rectal cancer patients who underwent LLND at the National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences between July 2014 and August 2021.According to the exclusion criteria,91 patients were excluded,and 105 patients were included in the final analysis.Patients were categorized into a neurological dysfunction group(n=78)and a normal neurological function group(n=27)based on their neurological status post-LLND.Clinicopathological data were compared between the two groups,and univariate and multivariate logistic regression analyses were conducted to identify influencing factors of postoperative neurological function.Results Among the 105 patients,27(25.7%)had normal neurological function,while 78(74.3%)experienced neurological dysfunction.Specifically,38 patients had urinary dysfunction,62 had sexual dysfunction,and 29 had lower limbs sensory and motor dysfunction.There were no significant differences in gender,age,preoperative neoadjuvant chemoradiotherapy,tumor T stage,presence of lymph node metastasis,and surgical approach between the two groups(P>0.05).A higher proportion of patients in the normal neurological function group underwent fascia-oriented LLND and unilateral LLND compared to the neurological dysfunction group(P<0.05).Univariate and multivariate logistic regression analyses revealed that fascia-oriented LLND was a protective factor for postoperative neurological function(OR=0.275,95%CI:0.106-0.720,P=0.019).Conclusion The incidence of postoperative neurological dysfunction is high in rectal cancer patients who undergo LLND.Fascia-oriented LLND is a protective factor for postoperative neurological function.