直肠癌保肛根治术后低位前切除综合征危险因素分析及列线图预测模型构建

直肠癌保肛根治术后低位前切除综合征危险因素分析及列线图预测模型构建直肠癌保肛根治术后低位前切除综合征危险因素分析及列线图预测模型构建

摘要：低位直肠癌保肛根治术后低位前切除综合征（LARS）是严重影响患者生活质量的术后并发症。本研究旨在探讨LARS的危险因素及构建列线图预测模型。收集了2014年1月至2019年12月的218例低位直肠癌保肛根治术后患者的门诊随访数据，经分析得到以下结论：1）患者年龄、BMI指数、病理分期、术后并发症、接近骶骨环距离、术后降低排便次数等因素是LARS的独立危险因素；2）根据列线图预测模型，不同危险因素的组合会影响LARS的发生概率；3）通过术前评估危险因素，医生可针对性地制定治疗方案，同时提高患者生活质量。

关键词：低位直肠癌；保肛根治术；低位前切除综合征；危险因素；列线图预测模型；生活质量

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