腹腔镜全直肠系膜切除保肛术后生活质量评估

目的对低位直肠癌患者行腹腔镜全直肠系膜切除保肛术(LTME ASP)后的生活质量进行评估。方法以2001年6月至2004年3月期间在四川大学华西医院直肠癌治疗组行LTME ASP的125例低位直肠癌患者为研究对象(LTME组),同期103例行开腹全直肠系膜切除保肛术(OTME ASP)的患者作为对照(OTME组),采用国际标准问卷QLQ-C30和QLQ-CR38,分别于术后3～6个月、12～18个月、>24个月3个时段进行前瞻性调查。结果LTME组的躯体功能、性功能及性快感分别在第1、2、3时段显著优于OTME组。两组女性性障碍差异无统计学意义,而LTME组在第1、2时段的排尿障碍和第2时段的男性性障碍均显著轻于OTME组。从第1时段到第2时段,两组的角色功能、认知功能、社会功能、未来期望、整体印象、疲乏、恶心呕吐、疼痛、失眠、厌食、腹泻、化疗副反应、排便障碍、消瘦以及LTME组的性功能、排尿障碍和男性性障碍均显著改善;而两组的性快感以及OTME组的性功能则在第3时段显著改善。结论LTME ASP治疗低位直肠癌可获得优于开腹手术的术后生活质量,其优势主要体现在躯体功能、排尿障碍、性功能、性快感、男性性障碍等方面,而以上优势主要存在于术后中、短期;LTME组和OTME组术后患者的生活质量均随时间延长趋于好转,术后1年最为显著,LTME组术后的排尿障碍和性功能比OTME组术后恢复快。

Evaluation of Life Quality Following Laparoscopic Total Mesorectal Excision for Low Rectal Cancers: A Clinical Control Study

Objective To prospectively evaluate the health-related quality of life(HRQOL)outcomes in patients undergoing laparoscopic total mesorectal excision(LTME)with anal sphincter preservation(ASP)for low rectal cancers.Methods From June 2001 to March 2004,125 patients undergoing LTME and 103 patients undergoing OTME were included in this study.The international standard questionnaires(QLQ-C30 and QLQ-CR38)were used to evaluate the conditions of patients at 3 periods after surgery respetively:3-6 months,12-18 months,>24 months.Results In contrast to OTME patients,the LTME ones showed significantly better physical function during 3-6 months after surgery,less micturition problems within 12-18 months,less male sexual problems and better sexual function during 12-18 months after surgery,with better sexual enjoyment after postoperative 24 months.Both groups showed significant improvement in most subscales from the first to the second assessment,and improvement in sexual enjoyment from the second to the third assessment.The sexual function,micturition problems and male sexual problems in LTME group significantly improved from the first to the second assessment,whereas the sexual function in OTME group improved from the second to the third assessment.Conclusion Patients undergoing LTME for low rectal cancers have better postoperative HRQOL than patients undergoing OTME,with better physical function,micturition function,overall sexual and male sexual functions in short term,and better sexual enjoyment in the long term.The HRQOL of both LTME and OTME patients may be expected to improve over time,particularly in the first postoperative year.