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背景和目的术前放/化疗可显著降低患者局部复发风险,因而被推荐用于Ⅱ/Ⅲ期直肠癌患者,这类多学科综合治疗的模式可能产生远期不良反应。本研究目的在于通过系统评价和荟萃分析确定术前放/化疗对术后肛肠功能、性功能以及排尿功能的远期影响。方法检索Pub Med、Embase以及Cochrane数据库,筛选有关接受术前放/化疗和直肠癌切除手术患者术后远期功能转归的相关研究文献。所有入选文献研究对象必须为术前放/化疗后接受全直肠系膜切除术(TME)患者,研究指标包括远期肛肠功能、性功能以及排尿功能。结果最终入选25项研究,共6 548例患者。大多数研究显示,术前放/化疗后,患者肛肠功能(14/18项)以及男性患者的性功能(9/10项)存在功能障碍。少数研究对女性的性功能障碍进行观察(4项)。荟萃分析表明,放疗患者更易出现大便失禁(RR=1.67,95%CI:1.36~2.05;P<0.0001)。此外,术前放/化疗后患者的直肠测压结果平均静息压力(加权平均差WMD=15.04,95%CI:0.77~29.31;P=0.04)以及最大收缩压力结果(加权平均差WMD=30.39,95%CI:21.48~39.3;P<0.0001)明显较差。男性勃起功能障碍方面差异无统计学意义(RR=1.41,95%CI:0.74~2.72;P=0.3)。8项研究中有6项以及荟萃分析都表明,术前放/化疗对患者排尿功能无明显不良影响(RR=1.05,95%CI:0.67~1.65;P=0.82)。结论尽管关注患者远期功能转归方面的高质量研究较为有限,但现有证据显示,术前放/化疗后进行TME手术对患者肛肠功能会产生负面影响。
BACKGROUND & OBJECTIVE: Preoperative radiotherapy / chemotherapy can significantly reduce the risk of local recurrence in patients with stage II / III rectal cancer. Such multidisciplinary approaches may have long-term adverse effects. The aim of this study was to determine the long-term effect of preoperative radiotherapy / chemotherapy on postoperative anorectal function, sexual function, and urinary function through systematic reviews and meta-analyzes. Methods PubMed, Embase and Cochrane databases were searched to screen the relevant literature about postoperative long-term functional outcomes in patients undergoing preoperative radiotherapy / chemotherapy and rectal cancer resection. All selected subjects must be enrolled in patients who have undergone total mesorectal excision (TME) after preoperative / postoperative chemotherapy. The indicators included long-term anorectal function, sexual function, and urinary function. The results were finally selected 25 studies, a total of 6 548 patients. Most studies have shown dysfunction of anorectal function (14/18) and sexual function (9/10) in patients after preoperative radiotherapy / chemotherapy. Few studies have looked at female sexual dysfunction (4 items). Meta-analyzes showed that patients on radiotherapy were more prone to fecal incontinence (RR = 1.67, 95% CI: 1.36-2.05; P <0.0001). In addition, the mean resting pressure (mean weighted WMD = 15.04, 95% CI: 0.77-29.31; P = 0.04) and maximum systolic pressure (weighted mean difference WMD = 30.39 , 95% CI: 21.48-39.3; P <0.0001) was significantly poorer. There was no significant difference in male erectile dysfunction (RR = 1.41, 95% CI: 0.74-2.72; P = 0.3). Six of the eight studies, as well as meta-analyzes, showed no significant adverse effects on urinary function in patients with preoperative radiotherapy (RR = 1.05, 95% CI: 0.67 to 1.65; P = 0.82). Conclusions Although high-quality studies focusing on long-term functional outcomes in patients are relatively limited, available evidence suggests that TME surgery after preoperative radiotherapy / chemotherapy may have a negative impact on anorectal function in patients.