在患有直肠癌的患者中,术后肠功能障碍 - - 微创手术方法是否能改善结果?
Richard Garfinkle1, Katherine A Bews2, William R G Perry1
1Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
概括
对直肠癌进行的最小侵入性手术 (MIS) 并不能降低长期肠道功能障碍的风险,称为低前切除综合征 (LARS). 在这项研究中,开放式手术和MIS方法显示了类似的LARS主要发病率.
科学领域:
- 结肠直肠手术 结肠直肠手术
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
背景情况:
- 结直肠癌手术可能导致长期的肠道功能障碍,影响患者的生活质量.
- 微创手术 (MIS) 越来越多地用于各种癌症类型,但其长期功能结果需要彻底评估.
- 低前切除综合征 (LARS) 是直肠癌手术后的一种常见且显著的并发症.
研究的目的:
- 研究直肠癌患者的微创手术 (MIS) 方法和长期术后肠功能障碍之间的关联.
- 为了比较开放式手术和MIS (腹腔镜或机器人) 之间主要LARS的发病率,用于直肠癌.
- 在接受手术切除的直肠癌患者中识别与主要LARS相关的因素.
主要方法:
- 一项观察性队列研究包括了2007年至2017年间接受了手术切除的直肠或直肠西格癌患者.
- 患者根据手术方法进行分类:开放式手术与MIS (透视镜或机器人) 相比.
- 测量的主要结果是主要LARS (LARS得分≥30),通过调查评估,随访时间中位数为6.1年.
主要成果:
- 在514名分析患者中,195名 (37.9%) 接受了MIS. 主要LARS发生在43.2%的患者中 (MIS:41.0%与开放:44.5%,p=0.44).
- 手术方法 (MIS与开放) 与较大的LARS没有关联 (aOR:1.21).
- 与主要LARS相关的因素包括年龄较大,女性性别,全腹腔切除术 (TME),转向静脉切除术和放射治疗.
结论:
- 对直肠癌进行的最小侵入性手术与大肠长期功能障碍 (LARS) 的风险降低无关.
- 这些发现表明,MIS不应该仅仅基于改善LARS的功能结果的前提来推广.
- 可能需要进一步的研究来探索影响不同外科手术方法后LARS的患者特异性因素.
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