直肠癌术后前切除综合征的研究进展
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摘要
随着外科技术的提高和医学器械的改进,越来越多的低位直肠癌患者在得到肿瘤的根治性切除的同时得以保留肛门,避免了永久性造瘘。然而,较大比例的低位保肛患者,术后会出现一系列的肛门及肠道功能障碍,我们称之为前切除综合征。手术成功而治疗失败的临床案例屡见不鲜,前切综合征的出现严重影响了患者的生活质量,但其机制和诊疗措施尚缺乏统一的认知,本文将对前切除综合征这一临床症状的研究进展进行综述。
Because of the improvement of surgical techniques and medical devices, More and more patients with low rectal cancer avoid permanent ostomy while obtaining radical resection of the tumor,However, a large proportion of patients with low anal sphincter will have a series of anal and intestinal dysfunction after surgery. We call it anterior resection syndrome. Successful surgery, failed treatment. Such clinical cases are not uncommon. The quality of life of patients is seriously affected because of anterior resection syndrome. There is still a lack of unified understanding of the mechanisms and treatments of ARS.The research progress on ARS is reviewed in this paper.
Because of the improvement of surgical techniques and medical devices, More and more patients with low rectal cancer avoid permanent ostomy while obtaining radical resection of the tumor,However, a large proportion of patients with low anal sphincter will have a series of anal and intestinal dysfunction after surgery. We call it anterior resection syndrome. Successful surgery, failed treatment. Such clinical cases are not uncommon. The quality of life of patients is seriously affected because of anterior resection syndrome. There is still a lack of unified understanding of the mechanisms and treatments of ARS.The research progress on ARS is reviewed in this paper.
引文
[1]Siegel R,Miller K,Jemal A.Cancer Statistics,2017[J].CA Cancer J Clin,2017,67(1):7-30.
[2]Chen W,Zheng R,Baade P,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[3]Bonjer H,Deijen C,Abis G,et al.A randomized trial of laparoscopic versus open surgery for rectal cancer[J].N Engl J Med,2015,372(14):1324-1332.
[4]Deijen C,Vasmel J,de Lange-de Klerk E,et al.Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer[J].Surgical Endoscopy,2017,31(6):2607-2615.
[5]van der Pas M,Haglind E,Cuesta M,et al.Laparoscopic versus open surgery for rectal cancer(COLOR II):short-term outcomes of a randomised,phase 3 trial[J].Lancet Oncol,2013,14(3):210-218.
[6]Blackmore A,Wong M,Tang C.Evolution of laparoscopy in colorectal surgery:an evidence-based review[J].World J Gastroenterol,2014,20(17):4926-4933.
[7]Tilney H,Heriot A,Purkayastha S,et al.A national perspective on the decline of abdominoperineal resection for rectal cancer[J].Ann Surg,2008,247(1):77-84.
[8]Chen T,Emmertsen K,Laurberg S.Bowel dysfunction after rectal cancer treatment:a study comparing the specialist′s versus patient′s perspective[J].BMJ Open,2014,4(1):e003374.
[9]Wells C,Vather R,Chu M,et al.Anterior resection syndrome--a risk factor analysis[J].J Gastrointest Surg,2015,19(2):350-359.
[10]Chen T,Wiltink L,Nout R,et al.Bowel function 14 years after preoperative short-course radiotherapy and total mesorectal excision for rectal cancer:report of a multicenter randomized trial[J].Clin Colorectal Cancer,2015,14(2):106-114.
[11]Bryant C,Lunniss P,Knowles C,et al.Anterior resection syndrome[J].Lancet Oncol,2012,13(9):e403-408.
[12]Ridolfi T,Berger N,Ludwig K.Low anterior resection syndrome:current management and future directions[J].Clinics in Colon and Rectal Surgery,2016,29(3):239-245.
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[20]Sato K,Inomata M,Kakisako K,et al.Surgical technique influences bowel function after low anterior resection and sigmoid colectomy[J].Hepatogastroenterology,2003,50(53):1381-1384.
[21]Heppell J,Kelly K,Phillips S,et al.Physiologic aspects of continence after colectomy,mucosal proctectomy,and endorectal ileo-anal anastomosis[J].Ann Surg,1982,195(4):435-443.
[22]Nesbakken A,Nygaard K,Lunde O.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.
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[25]Iizuka I,Koda K,Seike K,et al.Defecatory malfunction caused by motility disorder of the neorectum after anterior resection for rectal cancer[J].Am J Surg,2004,188(2):176-180.
[26]Croese A,Lonie J,Trollope A,et al.A meta-analysis of the prevalence of Low Anterior Resection Syndrome and systematic review of risk factors[J].Int J Surg,2018,56:234-241.
[27]吴国举,贾文焯,安琦,等.直肠术后低位前切除综合征高危因素分析[J].中华医学杂志,2018,(12):719-720.
[28]Qin Q,Huang B,Cao W,et al.Bowel Dysfunction After Low Anterior Resection With Neoadjuvant Chemoradiotherapy or Chemotherapy Alone for Rectal Cancer:A Cross-Sectional Study from China[J].Dis Colon Rectum,2017,60(7):697-705.
[29]van Heinsbergen M,Janssen-Heijnen M,Leijtens J,et al.Bowel dysfunction after sigmoid resection underestimated:Multicentre study on quality of life after surgery for carcinoma of the rectum and sigmoid[J].Eur J Surg Oncol,2018,44(8):1261-1267.
[30]Trenti L,Galvez A,Biondo S,et al.Quality of life and anterior resection syndrome after surgery for mid to low rectal cancer:Across-sectional study[J].Eur J Surg Oncol,2018,44(7):1031-1039.
[31]Emmertsen K,Laurberg S.Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer[J].Br J Surg,2013,100(10):1377-1387.
[32]Bregendahl S,Emmertsen K,Lous J,et al.Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer:a population-based cross-sectional study[J].Colorectal Dis,2013,15(9):1130-1139.
[33]Jimenez-Gomez L,Espin-Basany E,Trenti L,et al.Factors associated with low anterior resection syndrome after surgical treatment of rectal cancer[J].Colorectal Dis,2017,DOI:10.1111/codi.13901.[Epub ahead of print].
[34]Hughes D,Cornish J,Morris C.Functional outcome following rectal surgery-predisposing factors for low anterior resection syndrome[J].International Journal of Colorectal Disease,2017,32(5):691-697.
[35]Jimenez-Gomez L,Espin-Basany E,Marti-Gallostra M,et al.Low anterior resection syndrome:a survey of the members of the American Society of Colon and Rectal Surgeons(ASCRS),the Spanish Association of Surgeons(AEC),and the Spanish Society of Coloproctology(AECP)[J].International Journal of Colorectal Disease,2016,31(4):813-823.
[36]Emmertsen K,Laurberg S.Low anterior resection syndrome score:development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer[J].Ann Surg,2012,255(5):922-928.
[37]Juul T,Ahlberg M,Biondo S,et al.International validation of the low anterior resection syndrome score[J].Ann Surg,2014,259(4):728-734.
[38]Hupkens B,Breukink S,Olde Reuver Of Briel C,et al.Dutch validation of the low anterior resection syndrome score[J].Colorectal Dis.2018.DOI:10.1111/codi.14228.[Epub ahead of print].
[39]Juul T,Battersby N,Christensen P,et al.Validation of the English translation of the low anterior resection syndrome score[J].Colorectal Dis,2015,17(10):908-916.
[40]Temple L,Bacik J,Savatta S,et al.The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer[J].Dis Colon Rectum,2005,48(7):1353-1365.
[41]Akizuki E,Matsuno H,Satoyoshi T,et al.Validation of the Japanese Version of the Low Anterior Resection Syndrome Score[J].World J Surg,2018,42(8):2660-2667.
[42]Martellucci J.Low Anterior Resection Syndrome:A Treatment Algorithm[J].Dis Colon Rectum,2016,59(1):79-82.
[43]Hoffman J,Tyler K,MacEachern S,et al.Activation of colonic mucosal 5-HT(4)receptors accelerates propulsive motility and inhibits visceral hypersensitivity[J].Gastroenterology,2012,142(4):844-854.e844.
[44]Takaki M,Goto K,Kawahara I.The 5-hydroxytryptamine 4Receptor Agonist-induced Actions and Enteric Neurogenesis in the Gut[J].J Neurogastroenterol Motil,2014,20(1):17-30.
[45]Itagaki R,Koda K,Yamazaki M,et al.Serotonin(5-HT3)receptor antagonists for the reduction of symptoms of low anterior resection syndrome[J].Clin Exp Gastroenterol,2014,7:47-52.
[46]Min Y,Rhee P.The clinical potential of ramosetron in the treatment of irritable bowel syndrome with diarrhea(IBS-D)[J].Therap Adv Gastroenterol,2015,8(3):136-142.
[47]Iwama T,Imajo M,Yaegashi K,et al.Self washout method for defecational complaints following low anterior rectal resection[J].Jpn J Surg,1989,19(2):251-253.
[48]Gosselink M,Darby M,Zimmerman D,et al.Long-term followup of retrograde colonic irrigation for defaecation disturbances[J].Colorectal Dis,2005,7(1):65-69.
[49]Rosen H,Robert-Yap J,Tentschert G,et al.Transanal irrigation improves quality of life in patients with low anterior resection syndrome[J].Colorectal Dis,2011,13(10):e335-338.
[50]J?rgensen C,Kamperis K,Modin L,et al.Transanal irrigation is effective in functional fecal incontinence[J].Eur J Pediatr,2017,176(6):731-736.
[51]Didailler R,Denost Q,Loughlin P,et al.Antegrade Enema After Total Mesorectal Excision for Rectal Cancer:The Last Chance to Avoid Definitive Colostomy for Refractory Low Anterior Resection Syndrome and Fecal Incontinence[J].Dis Colon Rectum,2018,61(6):667-672.
[52]Michelsen H,Buntzen S,Krogh K,et al.Rectal volume tolerability and anal pressures in patients with fecal incontinence treated with sacral nerve stimulation[J].Dis Colon Rectum,2006,49(7):1039-1044.
[53]Tan E,Ngo N,Darzi A,et al.Meta-analysis:sacral nerve stimulation versus conservative therapy in the treatment of faecal incontinence[J].International Journal of Colorectal Disease,2011,26(3):275-294.
[54]朱元增,吴刚,张建成,等.骶神经刺激疗法治疗排粪失禁的Meta分析[J].中华胃肠外科杂志,2017,12(20):1417-1421.
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[2]Chen W,Zheng R,Baade P,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[3]Bonjer H,Deijen C,Abis G,et al.A randomized trial of laparoscopic versus open surgery for rectal cancer[J].N Engl J Med,2015,372(14):1324-1332.
[4]Deijen C,Vasmel J,de Lange-de Klerk E,et al.Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer[J].Surgical Endoscopy,2017,31(6):2607-2615.
[5]van der Pas M,Haglind E,Cuesta M,et al.Laparoscopic versus open surgery for rectal cancer(COLOR II):short-term outcomes of a randomised,phase 3 trial[J].Lancet Oncol,2013,14(3):210-218.
[6]Blackmore A,Wong M,Tang C.Evolution of laparoscopy in colorectal surgery:an evidence-based review[J].World J Gastroenterol,2014,20(17):4926-4933.
[7]Tilney H,Heriot A,Purkayastha S,et al.A national perspective on the decline of abdominoperineal resection for rectal cancer[J].Ann Surg,2008,247(1):77-84.
[8]Chen T,Emmertsen K,Laurberg S.Bowel dysfunction after rectal cancer treatment:a study comparing the specialist′s versus patient′s perspective[J].BMJ Open,2014,4(1):e003374.
[9]Wells C,Vather R,Chu M,et al.Anterior resection syndrome--a risk factor analysis[J].J Gastrointest Surg,2015,19(2):350-359.
[10]Chen T,Wiltink L,Nout R,et al.Bowel function 14 years after preoperative short-course radiotherapy and total mesorectal excision for rectal cancer:report of a multicenter randomized trial[J].Clin Colorectal Cancer,2015,14(2):106-114.
[11]Bryant C,Lunniss P,Knowles C,et al.Anterior resection syndrome[J].Lancet Oncol,2012,13(9):e403-408.
[12]Ridolfi T,Berger N,Ludwig K.Low anterior resection syndrome:current management and future directions[J].Clinics in Colon and Rectal Surgery,2016,29(3):239-245.
[13]葛欣,王锡山.低位前切除综合征研究进展[J].中华胃肠外科杂志,2011,14(12):994-998.
[14]Emmertsen K,Bregendahl S,Fassov J,et al.A hyperactive postprandial response in the neorectum--the clue to low anterior resection syndrome after total mesorectal excision surgery?[J].Colorectal Dis,2013,15(10):e599-606.
[15]Tabe Y,Mochiki E,Ando H,et al.Correlation between colonic motility and defecatory disorders after anterior resection of the rectum in canine models[J].Neurogastroenterol Motil,2008,20(10):1174-1184.
[16]Tomita R,Igarashi S,Fujisaki S,et al.Studies on anal canal sensitivity in patients with or without soiling after low anterior resection for lower rectal cancer[J].Hepato-gastroenterology,2008,55(85):1311-1314.
[17]Lee W,Takahashi T,Pappas T,et al.Surgical autonomic denervation results in altered colonic motility:an explanation for low anterior resection syndrome?[J].Surgery,2008,143(6):778-783.
[18]Adachi Y,Kakisako K,Sato K,et al.Factors influencing bowel function after low anterior resection and sigmoid colectomy[J].Hepatogastroenterology,2000,47(31):155-158.
[19]Mari G,Crippa J,Cocozza E,et al.Low Ligation of Inferior Mesenteric Artery in Laparoscopic Anterior Resection for Rectal Cancer Reduces Genitourinary Dysfunction:Results From a Randomized Controlled Trial(HIGHLOW Trial)[J].Ann Surg,2018.DOI:10.1097/SLA.0000000000002947.[Epub ahead of print].
[20]Sato K,Inomata M,Kakisako K,et al.Surgical technique influences bowel function after low anterior resection and sigmoid colectomy[J].Hepatogastroenterology,2003,50(53):1381-1384.
[21]Heppell J,Kelly K,Phillips S,et al.Physiologic aspects of continence after colectomy,mucosal proctectomy,and endorectal ileo-anal anastomosis[J].Ann Surg,1982,195(4):435-443.
[22]Nesbakken A,Nygaard K,Lunde O.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.
[23]Romaniszyn M,Richter P,Walega P,et al.Low-anterior-resection syndrome.How does neoadjuvant radiotherapy and low resection of the rectum influence the function of anal sphincters in patients with rectal cancer?Preliminary results of a functional assessment study[J].Pol Przegl Chir,2012,84(4):177-183.
[24]秦启元,黄斌杰,王磊.重视直肠癌低位前切除综合征的预防与治疗[J/CD].中华结直肠疾病电子杂志,2016,5(3):198-203.
[25]Iizuka I,Koda K,Seike K,et al.Defecatory malfunction caused by motility disorder of the neorectum after anterior resection for rectal cancer[J].Am J Surg,2004,188(2):176-180.
[26]Croese A,Lonie J,Trollope A,et al.A meta-analysis of the prevalence of Low Anterior Resection Syndrome and systematic review of risk factors[J].Int J Surg,2018,56:234-241.
[27]吴国举,贾文焯,安琦,等.直肠术后低位前切除综合征高危因素分析[J].中华医学杂志,2018,(12):719-720.
[28]Qin Q,Huang B,Cao W,et al.Bowel Dysfunction After Low Anterior Resection With Neoadjuvant Chemoradiotherapy or Chemotherapy Alone for Rectal Cancer:A Cross-Sectional Study from China[J].Dis Colon Rectum,2017,60(7):697-705.
[29]van Heinsbergen M,Janssen-Heijnen M,Leijtens J,et al.Bowel dysfunction after sigmoid resection underestimated:Multicentre study on quality of life after surgery for carcinoma of the rectum and sigmoid[J].Eur J Surg Oncol,2018,44(8):1261-1267.
[30]Trenti L,Galvez A,Biondo S,et al.Quality of life and anterior resection syndrome after surgery for mid to low rectal cancer:Across-sectional study[J].Eur J Surg Oncol,2018,44(7):1031-1039.
[31]Emmertsen K,Laurberg S.Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer[J].Br J Surg,2013,100(10):1377-1387.
[32]Bregendahl S,Emmertsen K,Lous J,et al.Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer:a population-based cross-sectional study[J].Colorectal Dis,2013,15(9):1130-1139.
[33]Jimenez-Gomez L,Espin-Basany E,Trenti L,et al.Factors associated with low anterior resection syndrome after surgical treatment of rectal cancer[J].Colorectal Dis,2017,DOI:10.1111/codi.13901.[Epub ahead of print].
[34]Hughes D,Cornish J,Morris C.Functional outcome following rectal surgery-predisposing factors for low anterior resection syndrome[J].International Journal of Colorectal Disease,2017,32(5):691-697.
[35]Jimenez-Gomez L,Espin-Basany E,Marti-Gallostra M,et al.Low anterior resection syndrome:a survey of the members of the American Society of Colon and Rectal Surgeons(ASCRS),the Spanish Association of Surgeons(AEC),and the Spanish Society of Coloproctology(AECP)[J].International Journal of Colorectal Disease,2016,31(4):813-823.
[36]Emmertsen K,Laurberg S.Low anterior resection syndrome score:development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer[J].Ann Surg,2012,255(5):922-928.
[37]Juul T,Ahlberg M,Biondo S,et al.International validation of the low anterior resection syndrome score[J].Ann Surg,2014,259(4):728-734.
[38]Hupkens B,Breukink S,Olde Reuver Of Briel C,et al.Dutch validation of the low anterior resection syndrome score[J].Colorectal Dis.2018.DOI:10.1111/codi.14228.[Epub ahead of print].
[39]Juul T,Battersby N,Christensen P,et al.Validation of the English translation of the low anterior resection syndrome score[J].Colorectal Dis,2015,17(10):908-916.
[40]Temple L,Bacik J,Savatta S,et al.The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer[J].Dis Colon Rectum,2005,48(7):1353-1365.
[41]Akizuki E,Matsuno H,Satoyoshi T,et al.Validation of the Japanese Version of the Low Anterior Resection Syndrome Score[J].World J Surg,2018,42(8):2660-2667.
[42]Martellucci J.Low Anterior Resection Syndrome:A Treatment Algorithm[J].Dis Colon Rectum,2016,59(1):79-82.
[43]Hoffman J,Tyler K,MacEachern S,et al.Activation of colonic mucosal 5-HT(4)receptors accelerates propulsive motility and inhibits visceral hypersensitivity[J].Gastroenterology,2012,142(4):844-854.e844.
[44]Takaki M,Goto K,Kawahara I.The 5-hydroxytryptamine 4Receptor Agonist-induced Actions and Enteric Neurogenesis in the Gut[J].J Neurogastroenterol Motil,2014,20(1):17-30.
[45]Itagaki R,Koda K,Yamazaki M,et al.Serotonin(5-HT3)receptor antagonists for the reduction of symptoms of low anterior resection syndrome[J].Clin Exp Gastroenterol,2014,7:47-52.
[46]Min Y,Rhee P.The clinical potential of ramosetron in the treatment of irritable bowel syndrome with diarrhea(IBS-D)[J].Therap Adv Gastroenterol,2015,8(3):136-142.
[47]Iwama T,Imajo M,Yaegashi K,et al.Self washout method for defecational complaints following low anterior rectal resection[J].Jpn J Surg,1989,19(2):251-253.
[48]Gosselink M,Darby M,Zimmerman D,et al.Long-term followup of retrograde colonic irrigation for defaecation disturbances[J].Colorectal Dis,2005,7(1):65-69.
[49]Rosen H,Robert-Yap J,Tentschert G,et al.Transanal irrigation improves quality of life in patients with low anterior resection syndrome[J].Colorectal Dis,2011,13(10):e335-338.
[50]J?rgensen C,Kamperis K,Modin L,et al.Transanal irrigation is effective in functional fecal incontinence[J].Eur J Pediatr,2017,176(6):731-736.
[51]Didailler R,Denost Q,Loughlin P,et al.Antegrade Enema After Total Mesorectal Excision for Rectal Cancer:The Last Chance to Avoid Definitive Colostomy for Refractory Low Anterior Resection Syndrome and Fecal Incontinence[J].Dis Colon Rectum,2018,61(6):667-672.
[52]Michelsen H,Buntzen S,Krogh K,et al.Rectal volume tolerability and anal pressures in patients with fecal incontinence treated with sacral nerve stimulation[J].Dis Colon Rectum,2006,49(7):1039-1044.
[53]Tan E,Ngo N,Darzi A,et al.Meta-analysis:sacral nerve stimulation versus conservative therapy in the treatment of faecal incontinence[J].International Journal of Colorectal Disease,2011,26(3):275-294.
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