预防性造口对腹腔镜直肠癌低位前切除术后短期生活质量的影响

目的:探讨预防性造口对腹腔镜直肠癌低位前切除术后患者短期生活质量的影响。方法:采用回顾性病例对照研究方法,纳入2015年5月—2016年5月空军军医大学附属唐都医院胃肠外科病例信息完整行低位前切除术的低位直肠癌患者98例,其中48例低位前切除术后行预防性回肠造口(造口组),50例未行预防性回肠造口(未造口组),比较两组患者的临床病理资料、术后低位前切除综合征评分和生活质量评分。结果:造口组接受新辅助放化疗的与病理分期较晚的患者明显多于未造口组(均P0.05);两组吻合口漏发生率、术中出血量、淋巴结清扫数目及术后住院时间差异无统计学意义(均P0.05);无论是否接受新辅助放化疗,造口组造口还纳后1年内低位前切除综合征评分明显低于未造口组术后1年内低位前切除综合征评分(P0.05);生活质量方面,造口组总体健康状况、躯体功能及情绪功能评分在术后3个月与6个月、社会功能和角色功能评分在术后3个月、腹泻状况评分在术后半年内均明显优于未造口组(均P0.05)。结论:预防性造口可减轻腹腔镜低位直肠癌前切除术患者术后低位前切除综合征症状的严重程度,并改善术后短期生活质量。

Influence of defunctioning ileostomy on short-term quality of life in patients after laparoscopic low anterior resection for rectal cancer

Objective: To investigate the influence of defunctioning ileostomy on short-term quality of life (QOL) in patients after laparoscopic low anterior resection for low rectal cancer. Methods: By retrospective case-control design, 98 patients with low rectal cancer undergoing low anterior resection in the Department of Gastrointestinal Surgery of Tangdu Hospital, Air Force Medical University from May 2015 to May 2016, who had complete clinical records were enrolled. Of the patients, 48 cases underwent defunctioning ileostomy following low anterior resection (ileostomy group) and 50 cases did not undergo defunctioning ileostomy (non-ileostomy group). The clinicopathologic data and the scores for postoperative low anterior resection syndrome and QOL between the two groups of patients were compared. Results: In ileostomy group, the number of patients receiving neoadjuvant chemoradiotherapy and patients with advanced pathological stage were higher than those in non-ileostomy group (both P<0.05). No statistical differences in incidence of anastomotic leakage, intraoperative blood loss, number of retrieved lymph nodes and length of postoperative hospital stay were noted between the two groups (all P>0.05). Despite of receiving neoadjuvant chemoradiotherapy or not, the scores for low anterior resection syndrome in ileostomy group within one year after ileostomy reduction were significantly lower than those in non-ileostomy group within one year after surgery (all P<0.05). In terms of QOL, the scores for global health, physical functioning and emotional functioning at postoperative 3 and 6 months, the scores for social functioning and role functioning at postoperative 3 months, and scores for diarrhea half a year after operation in ileostomy group were significantly superior to those in non-ileostomy group (all P<0.05). Conclusion: Defunctioning ileostomy can alleviate the severity of low anterior resection syndrome and improve postoperative short-term QOL in patients after laparoscopic low anterior resection for low rectal cancer.