使用混合效应模型进行腹腔镜超低直肠癌手术后门功能的一项多中心前性研究
Makoto Takahashi1, Kazuhiro Sakamoto1, Yuichiro Tsukada2
1Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan.
概括
保护门的直肠癌手术最初会损害门功能,后者逐渐恢复. 间切除 (ISR) 和年龄较大与更糟糕的结果有关.
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:
- 从历史上看,永久性结肠静脉切除是非常低的直肠癌的标准.
- 越来越多地采用关切除 (ISR) 和前下切除 (LAR) 等关保护技术.
- 手术后门功能是一个关键问题,特别是在非常低的门.
研究的目的:
- 为了评估直肠癌手术后门功能变化.
- 为了确定与术后门功能恶化相关的因素.
主要方法:
- 在47个中心 (2014-2017年) 进行前性单臂II期试验.
- 278名患有临床I期非常低的直肠癌的患者接受了腹腔镜手术.
- 韦克斯纳评分问卷和混合效应模型分析.
主要成果:
- 3个月后门功能暂时下降,但在3年内恢复到可接受的水平.
- 低前切除 (LAR) 导致明显更好的门功能,而不是间切除 (ISR).
- ISR和年龄较大 (≥75岁) 是术后门功能较差的独立预测因素.
结论:
- 直肠癌手术导致最初的门功能障碍,随后逐渐恢复.
- 脊髓间切除 (ISR) 和晚年增加门功能不良的风险.
- 知情同意应包括与患者讨论这些风险因素.
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