低位前切除综合征诊治中国专家共识（2025版）

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doi: 10.7659/j.issn.1005-6947.250357 ## 低位前切除综合征诊治中国专家共识（2025版） 中国医师协会肛肠医师分会 摘　要 低位前切除综合征（LARS）是直肠癌患者保肛术后常见的肠道功能障碍症候群，以储便与排空功能障碍为特征，已成为影响患者术后生活质量与临床结局的重要因素。目前对于LARS的致病机制尚不完全明确，仍缺少高质量循证依据指导临床实践。通过制定合理的肿瘤治疗方案、选择适宜的手术方式、评估真实的多维度症状特征、应用有效的预防干预策略以及实施规范的全程管理，能够有效减轻LARS症状的严重程度，进而改善患者生活质量。鉴于国内各级临床医师在LARS诊治过程中缺乏指导性共识意见，中国医师协会肛肠医师分会组织国内相关领域专家，检索并复习国内外研究成果，借鉴国外经验和指南，并结合国内实际情况，制定了《低位前切除综合征诊治中国专家共识（2025版）》。该共识从LARS的定义、临床表现、危险因素、病理生理机制、症状评估、治疗方法和预防策略等方面进行阐述，以期促进我国直肠癌患者保肛术后LARS的规范化诊治。 关键词 直肠肿瘤；排便；低位前切除综合征/诊断；低位前切除综合征/治疗；多数赞同 中图分类号： R735.3 Chinese expert consensus on the diagnosis and treatment of low anterior resection syndrome (2025 Edition) Chinese Society of Coloproctology, Chinese Medical Doctor Association Abstract　Low anterior resection syndrome (LARS) is a common bowel dysfunction syndrome following sphincter-preserving surgery for rectal cancer, characterized by stool storage dysfunction and evacuatory dysfunction. It has become a critical factor adversely affecting patients' quality of life and long-term clinical outcomes. Currently, the pathogenic mechanisms of LARS remain incompletely elucidated, and high-quality evidence to guide clinical practice is still lacking. However, emerging evidence suggests that strategic optimization across the clinical management pathway—including precision oncology planning, surgical technique selection, multidimensional symptom profiling, proactive prevention protocols, and comprehensive symptom management—may effectively reduce LARS severity and improve survivorship outcomes. Given the absence of consensus guidelines for LARS management among clinicians across China, the Chinese Society of Coloproctology of Chinese Medical Doctor Association organized domestic experts in relevant fields. Through systematic review of global research findings, integration of international expertise and guidelines, and adaptation to domestic clinical realities, we developed the Chinese expert consensus on the diagnosis and treatment of low anterior resection syndrome (2025 edition). This consensus elaborates on key aspects including the definition, clinical manifestations, risk factors, pathophysiological mechanisms, symptom assessment, treatment modalities, and prevention strategies for LARS, aiming to standardize the diagnosis and management of LARS in China. Key words　 Rectal Neoplasms; Defecation; Low Anterior Resection Syndrome/diag; Low Anterior Resection Syndrome/ther; Consensus CLC number: R735.3 低位前切除综合征（low anterior resection syndrome，LARS）是直肠癌患者保肛术后常见的肠道功能障碍症候群，已成为影响患者生活质量与临床结局的重要因素。鉴于LARS临床表现复杂多样，各级临床医师在疾病诊治过程中缺乏指导性共识意见，中国医师协会肛肠医师分会组织国内相关领域专家，检索并复习国内外研究成果，借鉴国外经验和指南，并结合国内实际情况，制定了《低位前切除综合征中国专家共识（2025版）》。本共识对LARS的定义、临床表现、危险因素、病理生理机制、症状评估、治疗方法和预防策略进行总结阐述，旨在为我国直肠癌患者保肛术后LARS的规范化诊治提供指导意见。 本共识制定步骤为：⑴ 工作组成员撰写共识内容及主要观点（推荐意见）及文献证据收集；⑵ 举行专家会议对全文主要观点提出修改意见，并进行无记名投票，主要观点通过率超过80%为通过；⑶ 总负责人根据专家意见及表决结果修改全文，发至各位专家，得到认可后为初定稿；⑷ 初定稿在专家组中讨论、修改，最后通过后为终稿。本共识采用证据质量和推荐强度分级系统（grading recommendations assessment，development and evaluation，GRADE）（表1）[1]。每项推荐意见的评估分值为1~9，其中7~9表示同意，4~6表示部分同意，1~3表示不同意。共54位专家对共识相关条目进行了投票。本共识在国际实践指南注册与透明化平台进行注册（注册号：2025CN936）。 表1 证据质量和推荐强度分级系统GRADE标准\n Table 1 The GRADE standard for the quality of evidence and recommendation strength grading system\n\n \n 证据质量等级 及推荐强度\n 说明\n \n \n 证据质量等级\n \n \n \n 高\n 随机对照试验(randomized controlled trial,RCT) 或高质量观察性研究; 进一步研究也不可能改变该疗效评估结果的可信度\n \n \n 中\n RCT或者观察性研究; 进一步研究很可能影响该疗效评估结果的可信度,且可能改变该评估结果\n \n \n 低\n RCT或者观察性研究;进一步研究有可能影响该疗效评估结果的可信度,且该评估结果很可能改变\n \n \n 极低\n 系列病例观察,低质量RCT,个案报道任何疗效评估结果很不确定\n \n \n 推荐强度\n \n \n \n 强烈推荐\n 支持或反对某项干预措施的强烈推荐,且利大于弊\n \n \n 条件推荐\n 支持或反对某项干预措施的条件推荐,利弊不确定\n \n\n\n 1　LARS的定义与临床表现 直肠癌保肛术后，高达60%~90%的患者会出现不同程度的肠功能障碍，显著影响生活质量，临床统称为LARS[2-3]。该综合征涵盖多种症状，主要包括大便失禁（20%~80%）、排便急迫感（30%~90%）、排空困难（30%~70%）及排便疼痛（20%~50%）等[4]。对各种症状的描述采用规范化术语，有助于提升不同研究及评估工具所获结果的一致性与可比性。 既往研究发现，吻合口位置越低的患者术后LARS症状越显著。例如，吻合口距肛缘 在BOREAL研究[49]中，应用了相似的阶梯式功能康复管理方案，即采用动态功能评估与个体化治疗方案调整，显著改善了直肠癌患者保肛术后的功能结局：重度LARS患者比例从术后30 d的48%降至术后1年的12%（P [29]Bregendahl S, Emmertsen KJ, Lous J, et al. 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