【摘要】 目的从生存质量的角度比较永久性造口及手术因素对中下段直肠癌患者术后生存质量的影响。方法本研究为前瞻性队列研究,选取2011年4月1日至2012年4月30日在中山大学第一附属医院胃肠外科行根治性手术治疗的全部中下段直肠癌患者,在手术前一周内、手术后第1、3、6月采用QLQ-C30与CR38量表进行生存质量数据采集。最终共65例患者完成了全部四次量表调查,其中造口组23例,无造口组42例。对造口组与无造口组生存质量得分进行同一时间节点组间比较,对造口组与无造口组组内手术前、术后4个时间点的各领域生存质量得分进行分析比较。结果无造口组在术后1个月时的角色功能(P=0.020)与总健康状况(P=0.025),3个月时的性功能(P=0.045)显著优于造口组。术后6个月时,造口组在3个症状领域:失眠(P=0.048),便秘(P<0.001)与腹泻(P=0.007)的生存质量优于无造口组。结论在术后3个月内,无造口组的生存质量略优于造口组。术后6个月时,保肛患者比造口患者受到了更多排便相关症状的困扰。无论造口与否,术后1个月时的生存质量在各时间点中都是最差的,术后1到6个月的生存质量均能逐渐恢复。更多还原

【Abstract】 Objective To compare the impact of permanent stoma and anus preservation operation on health-related quality of life(HRQOL) of patients with mid-low rectal cancer after radical surgery. Methods This study was a prospective cohort study. Patients with mid-low rectal cancer who underwent primary radical surgery at the Department of Gastrointestinal Surgery of The First Affiliated Hospital of Sun Yat-sen University from April 1st, 2011 to April 30 th, 2012 were prospectively enrolled following the inclusion and exclusion criteria and divided into two groups(stoma and no-stoma group). Assessment of HRQOL was performed by using two validated questionnaires: QLQ-C30 and CR-38 questionnaires at four time-points:within 1 week before surgery and 1, 3, 6 months after surgery. Finally, sixty-five patients completed all four times of questionnaire surveys. Among them, the stoma group enrolled 23 cases and the no-stoma group included 42 cases. Differences in each scale of QLQ-C30 and CR-38 questionnaires between stoma and no-stoma group at the same time-point were compared and analyzed. Changes in each scale of QLQ-C30 and CR-38 questionnaires in each group were analyzed. Results The no-stoma group had better HRQOL scores in scales of physical function(P=0.020) and global health status(P=0.025) when assessing at the first month postoperatively, in scale of sexual function(P=0.045) when assessing at the third month postoperatively. When assessing at the sixth month postoperatively, quality of life were better for stoma group than no-stoma group in insomnia(P =0.048), constipation(P <0.001) and diarrhea(P =0.007). Conclusions The quality of life in no-stoma group is better than that of stoma group at the third month after surgery. At six months after operation, the no-stoma group will suffer from more defecation-related inconveniences than the stoma group.Quality of life at the first postoperative month is the worst among the four time-points both in stoma and no-stoma group. From one to six months after operation, the quality of life of patients can be gradually restored.更多还原