直肠癌病人术后生活质量的评估

目的　探讨直肠癌经腹会阴根治术(APE)和前切除术(AR)对病人生活质量的影响情 况。方法　对行APE的病人29例和行AR的病人41例进行术后1年两次随访,用QLQ CR38的主 要评价项目评估其生活质量。结果　HAR组与LAR组相比,术后3～6个月时生活质量有显著性差 异(P<0.05);术后9～12个月,仅腹泻项目有显著性差异;APE组和LAR组的病人在术后1年内生 活质量无显著性差异;APE组和HAR组相比,术后9～12个月时生活质量有明显差别的项目较3～ 6个月时增多。随着时间的延长,3组病人的生活质量均有明显改善(P<0.05)。结论　LAR与 APE和HAR相比,仅在术后短期内(<9个月)生活质量有一定差别,在确保肿瘤切除、降低局部复 发率的前提下,应尽量行AR(LAR)为病人保留肛门并进一步研究改良AR手术方式。

Evaluation of quality of life in patients with rectal cancer undergoing abdominoperineal extirpation and anterior resection

Objective To evaluate the quality of life (QOL) in patients with rectal cancer undergoing anterior resection (AR) or abdominoperineal extirpation (APE) in a sample of patients recruited from a field trial.Methods Twenty-nine patients treated with APE and 41 patients treated with AR were followed up. QOL was assessed two times after surgery in one year with the main items of QLQ-CR38. Significant results (P< 0.05 ) were obtained 3 to 6 months after surgery in APE or LAR and HAR. Global QOF and social function revealed a main difference 9 to 12 months after surgery between APE and HAR. There was no significant difference between APE and LAR after surgery. All the patients' QOL was obviously improved in one year.Conclusion Patients undergoing LAR do not have a significant worse QOL than those subject to APE or HAR. Our ultimate goal should be to amend the AR to improve QOL significantly after surgery but not sphincter-saving only.