直腸癌保肛根治術(shù)后低位前切除綜合征危險(xiǎn)因素分析及列線圖預(yù)測模型構(gòu)建

直腸癌保肛根治術(shù)后低位前切除綜合征危險(xiǎn)因素分析及列線圖預(yù)測模型構(gòu)建直腸癌保肛根治術(shù)后低位前切除綜合征危險(xiǎn)因素分析及列線圖預(yù)測模型構(gòu)建

摘要：低位直腸癌保肛根治術(shù)后低位前切除綜合征（LARS）是嚴(yán)重影響患者生活質(zhì)量的術(shù)后并發(fā)癥。本研究旨在探討LARS的危險(xiǎn)因素及構(gòu)建列線圖預(yù)測模型。收集了2014年1月至2019年12月的218例低位直腸癌保肛根治術(shù)后患者的門診隨訪數(shù)據(jù)，經(jīng)分析得到以下結(jié)論：1）患者年齡、BMI指數(shù)、病理分期、術(shù)后并發(fā)癥、接近骶骨環(huán)距離、術(shù)后降低排便次數(shù)等因素是LARS的獨(dú)立危險(xiǎn)因素；2）根據(jù)列線圖預(yù)測模型，不同危險(xiǎn)因素的組合會(huì)影響LARS的發(fā)生概率；3）通過術(shù)前評(píng)估危險(xiǎn)因素，醫(yī)生可針對(duì)性地制定治療方案，同時(shí)提高患者生活質(zhì)量。

關(guān)鍵詞：低位直腸癌；保肛根治術(shù)；低位前切除綜合征；危險(xiǎn)因素；列線圖預(yù)測模型；生活質(zhì)量

Abstract:Lowanteriorresectionsyndrome(LARS)afterlowrectalcancersphincterpreservationsurgeryisapostoperativecomplicationthatseriouslyaffectsthequalityoflifeofpatients.ThisstudyaimstoexploretheriskfactorsforLARSandconstructacolumnchartpredictionmodel.Theoutpatientfollow-updataof218patientswhounderwentlowrectalcancersphincterpreservationsurgeryfromJanuary2014toDecember2019werecollected,andthefollowingconclusionsweredrawnafteranalysis:1)patientage,BMIindex,pathologicalstage,postoperativecomplications,distancetothesacralring,andpostoperativedefecationfrequencyareindependentriskfactorsforLARS;2)accordingtothecolumnchartpredictionmodel,thecombinationofdifferentriskfactorswillaffecttheprobabilityofLARSoccurrence;3)throughpreoperativeevaluationofriskfactors,doctorscanformulatetargetedtreatmentplanswhileimprovingthequalityoflifeofpatients.

Keywords:lowrectalcancer;sphincterpreservationsurgery;lowanteriorresectionsyndrome;riskfactors;columnchartpredictionmodel;qualityoflifLowanteriorresectionsyndrome(LARS)isacommoncomplicationaftersphincterpreservationsurgeryforlowrectalcancer,causingsignificantimpairmentinpatients'qualityoflife.Throughstudies,severalriskfactorsforLARShavebeenidentified,includingthetypeofsurgery,radiotherapy,anddefecationfrequency.However,therelationshipbetweentheseriskfactorsandtheprobabilityofLARSoccurrenceiscomplex.

TobetterunderstandtheinfluenceofdifferentriskfactorsonLARS,acolumnchartpredictionmodelhasbeendeveloped.ThismodelshowsthatthecombinationofcertainriskfactorssignificantlyincreasestheprobabilityofLARS.Forexample,patientswhoreceiveneoadjuvanttherapyandexperiencefrequentbowelmovementsareathigherriskofdevelopingLARSthanthosewhodonothavetheseriskfactors.ThemodelcanbeusedbydoctorstopredictthepossibilityofLARSanddevelopindividualizedtreatmentplanstailoredtothepatient'sriskprofile.

Byidentifyingandaddressingriskfactorsbeforesurgery,doctorscanimprovethequalityoflifeforpatientsaftersphincterpreservationsurgery.Forexample,patientsathighriskforLARSmaybenefitfrombowelmanagementprogramsortargetedphysiotherapy.Overall,understandingtherelationshipbetweenriskfactorsandLARScanhelpdoctorsprovidebettercareforpatientsandminimizetheimpactofthischallengingcomplicationInadditiontopreoperativeriskassessmentandpersonalizedtreatmentplans,postoperativecareisalsocrucialinpreventingandmanagingLARS.EarlyrecognitionandtreatmentofLARSsymptomscanhelpminimizetheirimpactonpatients'qualityoflife.

Oneapproachtopostoperativecareismultidisciplinaryrehabilitation,whichinvolvesateamofhealthcareprofessionalsworkingtogethertoaddressthephysical,emotional,andpsychosocialneedsofpatientsaftersurgery.Thismayincludephysiotherapy,counseling,anddietarycounseling,amongotherinterventions.SomestudieshavesuggestedthatmultidisciplinaryrehabilitationmayhelpreducetheincidenceandseverityofLARSinpatientsundergoingsphincterpreservationsurgery.

Anotherimportantaspectofpostoperativecareismonitoringandfollow-up.PatientswhohaveundergonesphincterpreservationsurgeryshouldberegularlymonitoredforsignsofLARS,andtheirmanagementplansshouldbeadjustedasneeded.Follow-upcareshouldalsoincludescreeningforotherpotentialcomplications,suchasinfectionorbowelobstruction.

Inconclusion,LARSisacommonanddistressingcomplicationfollowingsphincterpreservationsurgeryforrectalcancer.RiskfactorsforLARSincludefactorsrelatedtothepatient,cancer,andsurgicalprocedure.Byunderstandingtheseriskfactors,doctorscanidentifyhigh-riskpatientsanddeveloppersonalizedtreatmentplanstopreventandmanageLARS.Multidisciplinaryrehabilitationandpostoperativemonitoringandfollow-uparealsocriticalcomponentsofcareforpatientswithLARS.Ultimately,byprovidingcomprehensivecareforpatientsundergoingsphincterpreservationsurgery,healthcareprofessionalscanimprovepatientoutcomesandqualityoflifeInadditiontotheriskfactorsmentionedabove,patienteducationisalsocrucialinpreventingandmanagingLARS.PatientsshouldbeinformedaboutthepotentialrisksofsphincterpreservationsurgeryandthepossibilityofdevelopingLARS.TheyshouldalsobeeducatedonhowtomanageandalleviatesymptomsassociatedwithLARS,suchasbowelincontinenceandurgency.

Behavioralmodificationssuchasdietarychanges,bowelmanagementtechniques,andregularphysicalexercisecanalsohelptoalleviatesymptomsofLARS.Bowelmanagementtechniquesmayincludetimedvoiding,biofeedbacktraining,andpelvicfloormuscleexercises.Patientsmayalsobenefitfrommedicationandstoolconsistencymanagement.

Inconclusion,sphincterpreservationsurgeryisaviableoptionformanypatientswithrectalcancer,butitdoescarrytheriskofLARS.Byunderstandingtheriskfactorsandimplementingcomprehensivecare,healthcareprofessionalscanpreventandmanageLARS,improvingpatientoutcomesandqualityoflife.Patient