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中华结直肠疾病电子杂志 ›› 2024, Vol. 13 ›› Issue (06) : 519 -523. doi: 10.3877/cma.j.issn.2095-3224.2024.06.011

所属专题: 经典病例

综述

LARS 评分的研制回顾与应用现状
王灿1,2, 樊昊1, 张卫1, 于冠宇1,2,()   
  1. 1.200433 上海,海军军医大学第一附属医院(上海长海医院)肛肠外科
    2.233004 蚌埠医科大学第一附属医院胃肠外科
  • 收稿日期:2024-07-06 出版日期:2024-12-25
  • 通信作者: 于冠宇
  • 基金资助:
    国家自然科学基金(No.82072750,No.82203137,No.82473479)海军军医大学第一附属医院基础医学研究专项(No.2023QD003,No.2023PY04)上海市卫生健康委员会卫生行业临床研究专项(No.20224Y0348)

A review of the development and current application status of the LARS score

Can Wang1,2, Hao Fan1, Wei Zhang1, Guanyu Yu1,2,()   

  1. 1.Department of Colorectal Surgery, Changhai Hospital, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
    2.Department of Gastrointestinal Surgery, the First Affiliated Hospital of Bengbu Medical University, Bengbu 233004, China
  • Received:2024-07-06 Published:2024-12-25
  • Corresponding author: Guanyu Yu
引用本文:

王灿, 樊昊, 张卫, 于冠宇. LARS 评分的研制回顾与应用现状[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 519-523.

Can Wang, Hao Fan, Wei Zhang, Guanyu Yu. A review of the development and current application status of the LARS score[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2024, 13(06): 519-523.

我国直肠癌发病率较高,低位前切除综合征(LARS)较为常见,通过LARS 评分,可以快速筛查LARS 患者的严重程度,为治疗提供指导。虽然LARS 评分快捷有效且具有较高的敏感度,但随着LARS 诊断标准的更新及对LARS 研究的深入,LARS 评分的特异度饱受争议,其内容也有待更新。LARS 严重影响直肠癌术后患者的生活质量,目前缺乏准确评估和精准预测术后LARS 的工具。该文旨在综述LARS 评分的研制与应用,总结目前存在的争议,为研制新的评分工具提供帮助。

The incidence of rectal cancer is relatively high in China, and low anterior resection syndrome (LARS) is common.The LARS score can be utilized for rapid screening of LARS patients’ severity and provide treatment guidance.Despite its speed, effectiveness, and high sensitivity, the specificity of the LARS score has been a subject of controversy due to evolving diagnostic criteria and deepening research on LARS.Therefore, its content requires updating.LARS significantly impacts the postoperative quality of life for patients with rectal cancer, and there is currently a lack of accurate assessment and precise prediction tools for postoperative LARS.This article aims to review the development and application of the LARS score while summarizing existing controversies to aid in the development of new scoring tools.

表1 LARS 评分的相关论述
序号 作者/发表年份 结果 论述
1 Emmertsen等[3]/2012年 敏感度:72.54%和特异度:82.52% 可识别LARS 患者并反映对生活质量的影响
2 Juul等[8]/2014 年 敏感度:瑞典81.9%,西班牙77.9%,德国67.7%,丹麦88.3%。特异度: 瑞典58.15%,西班牙78.6%,德国86.3%,丹麦75.9% 评估欧洲直肠癌根治术后LARS 患者的有效工具
3 Ribas等[37]/2016 年 70 例根治性直肠癌前切除术后的患者,5 例被归类为无LARS 但有严重的排空功能障碍,13 例被归类为LARS 但无明显的肠功能障碍,其中9 例被归类为重度LARS LARS 评分低估排空功能障碍的影响
4 Heinsbergen等[42]/2018 年 249 名乙状结肠切除术后患者,轻度LARS 占18.9%,重度LARS 占21.7% 乙状结肠癌根治术后患者存在重度LARS
5 Van der Sande等[43]/2019 年 33 例接受放疗后等待观察治疗的原发性直肠癌患者,33.3%的患者存在重度LARS 接受放疗的直肠癌患者存在重度LARS
6 Juul等[44]/2019 年 3 440 例丹麦公民,15% 的女性和9.9% 的男性被归类为重度LARS,在50 岁至79 岁公民中,重度LARS 占比为19% 重度LARS 在健康人群较常见,分析组间LARS 评分差异需考虑合并症的影响
7 Heinsbergen等[31]/2019 年 501 例无胃肠道肿瘤和腹部手术史患者,重度LARS 占15%,其中女性占比高于男性 直肠癌术后部分重度LARS 由预先存在的其他因素导致
8 Al-Saidi等[30]/2020 年 1 259 名健康荷兰人,24.3% 有轻度LARS,12.2% 有重度LARS 荷兰健康人群中存在轻度和重度LARS 患者
9 Ketelaers等[32]/2022 年 1 183 例结肠癌患者,70 岁以上结肠癌术后患者重度LARS占比为22.2%,70 岁以下结肠癌术后患者重度LARS 占比为20.4% 结肠癌患者发现重度LARS 且显著损害生活质量
10 Dulskas等[29]/2022 年 8 041 人组成一般人群队列,36.4% 的参与者有轻微的LARS 症状,14.2% 的参与者有严重的LARS 症状 LARS 评分中包含的症状在一般人群中很常见
11 Wang等[38]/2023 年 136 例患者,无肠道相关生活质量(BQOL)受损的患者中23% 为轻度或重度LARS,严重BQOL 受损有32% 为无或轻度LARS 直肠癌术后患者报告的BQOL 与健康调查简表SF-36 的相关性高于LARS评分
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