低前切除综合征的预防策略
H Brock1,2,3, L Lambrineas1, H I Ong4,5
1Austin Health, Department of Surgery, University of Melbourne, Melbourne, Australia.
Techniques in coloproctology
|December 13, 2023
概括
在直肠癌手术后预防低前切除综合征 (LARS) 是至关重要的. 像过管灌和骨盆底康复等策略显示出希望,但在患者坚持和可访问性方面面临挑战.
科学领域:
- 结肠直肠手术 结肠直肠手术
- 在瘤学瘤学.
- 胃肠病学 胃肠病学
背景情况:
- 低前切除综合征 (LARS) 是直肠癌手术后的一种常见,使人衰弱的并发症.
- LARS是多因素的,不太了解,并且难以治疗,预防策略经常被忽视.
研究的目的:
- 审查LARS的病理生理学.
- 探索目前关于预防LARS预防的预防技术的有效性和可行性的证据.
主要方法:
- 从2000年1月到2023年10月进行了一项文献综述.
- 在Medline,Cochrane和PubMed数据库的搜索中,在选189篇文章后,确定了18项研究进行审查.
主要成果:
- LARS的发展涉及结肠动性,关节功能障碍和神经直肠功能障碍,破坏排便.
- 过门灌 (TAI) 和盆地康复 (PFR) 显示了LARS预防的好处,但受到患者遵守的限制.
- 在手术期间的神经监测 (IONM) 和机器人辅助手术 (RAS) 显示了对外科LARS预防的希望.
结论:
- 预防策略 (IONM,RAS,PFR,TAI) 的证据有限.
- 当前LARS预防策略的关键局限性是获取和患者接受度.
- 目前正在进行的试验和技术进步有望提高这些干预措施的可访问性和可接受性.
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