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ENGLISH ABSTRACT
关注低位前切除综合征的全程化管理与分阶梯治疗的实施
叶颖江
作者及单位信息
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DOI： 10.3760/cma.j.cn113855-20241215-00783
Highlight and promotion of comprehensive management and stepwise treatment for low anterior resection syndrome
Ye Yingjiang
Authors Info & Affiliations
Ye Yingjiang
Department of Gastrointestinal Surgery, Peking University People's Hospital, Laboratory of Surgical Oncology, Peking University People's Hospital, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing 100044, China
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DOI： 10.3760/cma.j.cn113855-20241215-00783
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摘要

随着直肠癌切除术后保肛率的提高，低位前切除综合征（LARS）引起了越来越多的重视。LARS的预防和治疗策略在过去的十几年持续改进，结直肠外科医师应重视LARS的术前-术中-术后的全程化管理，术前充分评估保肛手术的风险和受益；术中进行神经功能保护，改进肠道重建方式，精准定位远端、近端切缘；术后按照肠功能恢复方案对LARS患者进行规范化分阶梯治疗。

直肠肿瘤;综合征;保留肛门括约肌手术;肠道功能
ABSTRACT

As the rate of sphincter-preserving surgery increases after proctectocy, low anterior resection syndrome (LARS) has gained increasing attention. The prevention and treatment strategies for LARS have continually improved over the past decade. Colorectal surgeons should focus on whole course management of LARS throughout the pre-, intra-and post-operative period. This includes through preoperative assessment of the risks and benefits of sphincter-preserving resections, intraoperative neurofunctional protection, improvements in bowel reconstruction techniques, and precise identification of distal and proximal margins. Postoperatively, LARS patients should receive standardized, stepwise treatment according to the bowel rehabilitation programme.

Rectal neoplasms;Syndrome;Sphincter-preserving resections;Bowel function
Ye Yingjiang, Email: nc.defudabe.hpukpgnaijgniyey
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引用本文

叶颖江. 关注低位前切除综合征的全程化管理与分阶梯治疗的实施[J]. 中华普通外科杂志,2025,40(02)：81-84.

DOI:10.3760/cma.j.cn113855-20241215-00783

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放眼直肠癌治疗历史进程，技术手段的革新和治疗方式的多元化推动着直肠癌“改善预后”和“保留功能”两大目标的实现。直肠癌功能保护是微创外科时代的必然要求，是“功能外科”理念的深刻诠释，是直肠癌诊疗迈向新的发展阶段的重要标志。低位前切除综合征（low anterior resection syndrome，LARS）是直肠癌保留肛门括约肌手术（sphincter- preserving resections，SPR）后面临的首要功能难题，近年来引起越来越多结直肠外科医师的重视。为总结阐述LARS的预防和诊疗进展，笔者从术前、术中、术后三个维度展开述评，同时呼吁广大结直肠外科医师重视LARS的全程化管理与分阶梯治疗。
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参考文献
[1]
Harroson JD , Solomon MJ , Young JM ,et al. Patient and physician preferences for surgical and adjuvant treatment options for rectal cancer[J]. Arch Surg, 2008,143(4):389-394. DOI: 10.1001/archsurg.143.4.389 .
返回引文位置Google Scholar
百度学术
万方数据
[2]
Gadan S , Floodeen H , Lindgren R ,et al. What is the risk of permanent stoma beyond five years after low anterior resection for rectal cancer?[J]. Colorectal Dis, 2020,22(12):2098-2104. DOI: 10.1111/codi.15364 .
返回引文位置Google Scholar
百度学术
万方数据
[3]
Klaiber U , Stephan -Paulsen LM , Bruckner T ,et al. Impact of preoperative patient education on the prevention of postoperative complications after major visceral surgery: the cluster randomized controlled PEDUCAT trial[J]. Trials, 2018,19(1):288. DOI: 10.1186/s13063-018-2676-6 .
返回引文位置Google Scholar
百度学术
万方数据
[4]
Hou S , Liu F , Shen ZL ,et al. Investigation on the status quo of diagnosis and treatment related to the protection of defecation function in sphincter-preserving resections for rectal cancer: a cross-sectional study of Chinese colorectal surgeons[J]. 中华胃肠外科杂志, 2021,24(4):319-326. DOI: 10.3760/cma.j.cn.441530-20200111-00015 .
返回引文位置Google Scholar
百度学术
万方数据
[5]
Battersby NJ , Bouliotis G , Emmertsen KJ ,et al. Development and external validation of a nomogram and online tool to predict bowel dysfunction following restorative rectal cancer resection: the POLARS score[J]. Gut, 2018,67(4):688-696. DOI: 10.1136/gutjnl-2016-312695 .
返回引文位置Google Scholar
百度学术
万方数据
[6]
Qin Q , Huang B , Wu A ,et al. Development and validation of a post-radiotherapy prediction model for bowel dysfunction after rectal cancer resection[J]. Gastroenterology, 2023,165(6):1430-1442. DOI: 10.1053/j.gastro.2023.08.022 .
返回引文位置Google Scholar
百度学术
万方数据
[7]
Wang Z , Zhou C , Meng L ,et al. Development and validation of an MRI and clinicopathological factors prediction model for low anterior resection syndrome in anterior resection of middle and low rectal cancer[J]. Heliyon, 2024,10(17):e36498. DOI: 10.1016/j.heliyon.2024.e36498 .
返回引文位置Google Scholar
百度学术
万方数据
[8]
Wallner C , Lange MM , Bonsing BA ,et al. Causes of fecal and urinary incontinence after total mesorectal excision for rectal cancer based on cadaveric surgery: a study from the Cooperative Clinical Investigators of the Dutch total mesorectal excision trial[J]. J Clin Oncol, 2008,26(27):4466-4472. DOI: 10.1200/JCO.2008.17.3062 .
返回引文位置Google Scholar
百度学术
万方数据
[9]
韩方海,周声宁. 直肠癌盆腔的膜解剖与网络保留自主神经手术[J]. 中华胃肠外科杂志, 2021,24(7):587-593. DOI: 10.3760/cma.j.cn.441530-20210506-00190 .
返回引文位置Google Scholar
百度学术
万方数据
[10]
Yavuz R , Aras O , Çiyiltepe H ,et al. Effect of robotic inferior mesenteric artery ligation level on low anterior resection syndrome in rectum cancer[J]. J Laparoendosc Adv Surg Tech A, 2024,34(5):387-392. DOI: 10.1089/lap.2023.0472 .
返回引文位置Google Scholar
百度学术
万方数据
[11]
张峻岭,董洁晶,吴涛,等. 直肠癌保肛根治术后低位前切除综合征危险因素的列线图分析[J]. 中华普通外科杂志, 2021,36(2):81-86. DOI: 10.3760/cma.j.cn113855-20200819-00648 .
返回引文位置Google Scholar
百度学术
万方数据
[12]
中华医学会肿瘤学会结直肠肿瘤学组. 直肠癌外科手术切缘中国专家共识(2024版)[J]. 中华胃肠外科杂志, 2024,27(6):545-558. DOI: 10.3760/cma.j.cn441530-20240403-00123
返回引文位置Google Scholar
百度学术
万方数据
[13]
Parnasa SY , Chill H , Helou B ,et al. Low anterior resection syndrome following rectal cancer surgery: are incidence and severity lower with long-term follow-up?[J]. Tech Coloproctol, 2022,26(12):981-989. DOI: 10.1007/s10151-022-02699-6 .
返回引文位置Google Scholar
百度学术
万方数据
[14]
Wu PH , Zhong QH , Ma TH ,et al. To what extent should the intestinal be resected proximally after radiotherapy: hint from a pathological view[J]. Gastroenterol Rep, 2020,8(4):277-285. DOI: 10.1093/gastro/goz047 .
返回引文位置Google Scholar
百度学术
万方数据
[15]
Liu F , Guo P , Wang Q ,et al. Excessive bowel volume loss during anus-preserving surgery for rectal cancer affects the bowel function after operation: a prospective observational cohort study (Bas-1611)[J]. Heliyon, 2023,9(7):e17630. DOI: 10.1016/j.heliyon.2023.e17630 .
返回引文位置Google Scholar
百度学术
万方数据
[16]
Nesbakken A , Nygaard K , Lunde OC . Mesorectal excision for rectal cancer: functional outcome after low anterior resection and colorectal anastomosis without a reservoir[J]. Colorectal Dis, 2002,4(3):172-176. DOI: 10.1046/j.1463-1318.2002.00305.x .
返回引文位置Google Scholar
百度学术
万方数据
[17]
侯栋,赵世栋,刘凡,等. 端侧吻合与端端吻合改善低位前切除术后排粪功能的安全性和有效性的Meta分析[J/CD]. 中华结直肠疾病电子杂志, 2021,10(4):391-399. DOI: 10.3877/cma.j.issn.2095-3224.2021.04.007 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Hou S , Wang Q , Zhao S ,et al. Safety and efficacy of side-to-end anastomosis versus colonic J-pouch anastomosis in sp hincter-preserving resections: an updated meta- analysis of randomized controlled trials [J]. World J Surg Oncol, 2021,19(1):130. DOI: 10.1186/s12957-021-02243-0 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
Rosen H , Sebesta CG , Sebesta C . Management of low anterior resection syndrome (LARS) following resection for rectal cancer[J]. Cancers, 2023,15(3):778. DOI: 10.3390/cancers15030778 .
返回引文位置Google Scholar
百度学术
万方数据
[20]
Harji D , Fernandez B , Boissieras L ,et al. A novel bowel rehabilitation programme after total mesorectal excision for rectal cancer: the BOREAL pilot study[J]. Colorectal Dis, 2021,23(10):2619-2626. DOI: 10.1111/codi.15812 .
返回引文位置Google Scholar
百度学术
万方数据
[21]
Kim MJ , Park S , Park JW ,et al. Gut microbiome associated with low anterior resection syndrome after rectal cancer surgery[J]. Sci Rep, 2023,13(1):8578. DOI: 10.1038/s41598-023-34557-2 .
返回引文位置Google Scholar
百度学术
万方数据
[22]
Verkuijl SJ , Jonker JE , Furnée EJB ,et al. The effect of a temporary stoma on long-term functional outcomes following surgery for rectal cancer[J]. Dis Colon Rectum, 2024,67(2):291-301. DOI: 10.1097/DCR.0000000000003009 .
返回引文位置Google Scholar
百度学术
万方数据
[23]
Tominaga K , Kamimura K , Takahashi K ,et al. Diversion colitis and pouchitis: a mini-review[J]. World J Gastroenterol, 2018,24(16):1734-1747. DOI: 10.3748/wjg.v24.i16.1734 .
返回引文位置Google Scholar
百度学术
万方数据
[24]
Beamish EL , Johnson J , Shih B ,et al. Delay in loop ileostomy reversal surgery does not impact upon post-operative clinical outcomes. Complications are associated with an increased loss of microflora in the defunctioned intestine[J]. Gut Microbes, 2023,15(1):2199659. DOI: 10.1080/19490976.2023.2199659 .
返回引文位置Google Scholar
百度学术
万方数据
[25]
Beamish EL , Johnson J , Shaw EJ ,et al. Loop ileostomy- mediated fecal stream diversion is associated with microbial dysbiosis[J]. Gut Microbes, 2017,8(5):467-478. DOI: 10.1080/19490976.2017.1339003 .
返回引文位置Google Scholar
百度学术
万方数据
[26]
Li T , Lu X , Yang X . Evaluation of clinical safety and beneficial effects of stachyose-enriched α-galacto-oligosaccharides on gut microbiota and bowel function in humans[J]. Food Funct, 2017,8(1):262-269. DOI: 10.1039/c6fo01290f .
返回引文位置Google Scholar
百度学术
万方数据
[27]
侯森,刘凡,申占龙,等. 中国结直肠外科医师对直肠癌保肛手术排粪功能保护相关的诊疗现状调查[J]. 中华胃 肠外科杂志 , 2021,24(4):319-327. DOI: 10.3760/cma.j.cn.441530-20200111-00015 .
返回引文位置Google Scholar
百度学术
万方数据
备注信息
A
叶颖江，Email： nc.defudabe.hpukpgnaijgniyey
B
叶颖江. 关注低位前切除综合征的全程化管理与分阶梯治疗的实施[J]. 中华普通外科杂志, 2025, 40(2): 81-84. DOI: 10.3760/cma.j.cn113855-20241215-00783.
C
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