Nurse-led standardized intervention for low anterior resection syndrome. A population-based pilot study
Nurse-led standardized intervention for low anterior resection syndrome. A population-based pilot study
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DOI：
10.1111/codi.15497
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发表时间：
2021-02-09
影响因子：
3.4
通讯作者：
Christensen, Peter
中科院分区：
文献类型：
--
作者：
Dalsgaard, Peter;Emmertsen, Katrine Jossing;Christensen, Peter
Aim我们的目的是研究在临床环境中实施低位前切除综合征（LARS）评分，并评估直肠癌手术后肠功能障碍的护士主导的标准化干预措施。方法使用LARS评分筛选2012年至2016年期间在单中心接受治愈性、恢复性直肠癌切除术的所有患者。在临床随访时，在护士主导的诊所为严重LARS患者提供治疗。结果286例患者中有190例（66%）进行了LARS评分，其中89例为主要LARS。共有86名患者要求治疗肠功能障碍，大多数患者在护士领导的优化保守治疗后获得了可接受的功能。17名患者继续进行经肛门冲洗，7名患者接受生物反馈治疗。5例患者转诊接受手术，3例患者接受胃肠病学评价。经临床治疗后，患者LARS评分中位数从37分（四分位距34-39分）下降到31分（四分位距23-34分）（P < 0.001），主要LARS患病率从95%下降到53%（P < 0.001）。大多数患有严重LARS的患者要求对其症状进行治疗，并且可以通过在护士主导的环境中进行的标准化干预措施成功治疗。
Aim Our aim was to study the implementation of the low anterior resection syndrome (LARS) score in a clinical setting and to evaluate a nurse-led standardized intervention for bowel dysfunction following rectal cancer surgery.Method All patients who underwent curatively intended, restorative rectal cancer resection in a single centre between 2012 and 2016 were screened using the LARS score. At clinical follow-up, patients with major LARS were offered treatment in a nurse-led clinic. Data were retrospectively collected from patients' electronic medical records.Results In total, 190 out of 286 (66%) patients were screened with the LARS score of whom 89 had major LARS. A total of 86 patients requested treatment for their bowel dysfunction and the majority obtained acceptable function after nurse-led optimized conservative treatment. Seventeen patients went on to transanal irrigation, and seven patients were treated with biofeedback. Five patients were referred for surgery, three for gastroenterological evaluation. After treatment in the clinic, patients achieved a statistically significant decrease in median LARS score from 37 (interquartile range 34-39) to 31 (interquartile range 23-34) (P < 0.001), and the prevalence of major LARS fell from 95% to 53% (P < 0.001).Conclusion Screening for LARS was not optimal as one-third of patients were not screened. The majority of patients with major LARS requested treatment for their symptoms and could be successfully treated with standardized interventions managed in a nurse-led setting.