新辅助治疗对局部进展期直肠癌患者的生活质量的影响

目的：探讨新辅助治疗对局部进展期中低位直肠癌患者的术前、术后的生活质量的影响。方法：将132例局部进展期的中低位直肠癌患者中47例接受术前新辅助治疗者作为观察组，另85例未行新辅助治疗者作为对照组，用欧洲癌症研究与治疗组织（EORTC）的生活质量核心量表QLQ-C30和QLQ-CR29评分来比较两组的生活质量。结果：术前观察组的整体生活质量和情绪功能评分明显低于对照组，疲乏、恶心呕吐、食欲丧失、腹泻、经济困难以及脱发、口干、味觉异常和焦虑症状评分均高于对照组，但脓血便症状评分低于对照组（均P<0.05）。术后6个月，两组间的整体生活质量评分差异无统计学意义（P=0.167），但是观察组的疼痛、腹泻以及排气、排便失禁和皮肤灼痛症状评分明显高于对照组（均P<0.05），而且腹泻的评分差异一直持续到术后12个月（P=0.023）。从术前至术后12个月，观察组的阳痿和性交困难症状评分均高于对照组明显，相应的男性性功能评分也一直低于对照组（均P<0.05），而女性患者的性功能评分只在术前低于对照组（P=0.017）。结论：对局部进展期的中低位直肠癌，新辅助治疗会影响患者的生活质量，并以胃肠道和性功能的影响尤为明显。

Impact of neoadjuvant therapy on quality of life in patients with locally advanced rectal cancer

Objective: To investigate the influence of neoadjuvant therapy on quality of life in patients with locally advanced mid/low rectal cancer before and after surgery. Methods: In 132 patients with locally advanced mid/low rectal cancer, 47 cases receiving preoperative neoadjuvant therapy were designated as observational group, and the remaining 85 cases who did not undergo preoperative neoadjuvant therapy were used as control group. The quality of life of the two groups was compared by the questionnaire scores of QLQ-C30 and QLQ-CR29 scale issued by European Organization for Research and Treatment of Cancer (EORTC). Results: Before operation, the scores for overall quality of life and emotional functioning in observational group were significantly lower than those in control group, while the scores for fatigue, nausea/vomiting, appetite loss, diarrhea, and financial problems as well as the scores for some symptoms that included hair loss, dry mouth, change of taste, and anxiety in observational group were significantly higher than those in control group (all P<0.05). Six months after operation, the scores for overall quality of life showed no statistical difference between the two groups (P=0.167), but the scores for pain, diarrhea, flatus or fecal incontinence, and burning skin pain in observational group were significantly higher than those in control group (all P<0.05), and moreover, the difference in diarrhea score persisted for up to 12 months after operation (P=0.023). The scores for impotence and dyspareunia were significantly higher and correspondingly, the score for sexual function was significantly lower in observational group than those in control group, which persisted from the preoperative stage to 12 months after operation (all P<0.05), however, the score for female sexual function in observation group was significantly lower than that in control group only in preoperative stage (P=0.017).Conclusion: Neoadjuvant therapy exerts a negative effect on the quality of life, especially the gastrointestinal and sexual function, in patients with locally advanced low rectal cancer.