难治性溃疡性结肠炎外科治疗对患者生活质量的影响研究

Quality of Life in Surgical Treatment of Refractory Ulcerative Colitis

目的评价二期行全结直肠切除-回肠贮袋肛管吻合(RP-IPAA)术对难治性溃疡性结肠炎(UC)患者生活质量的影响。方法对2008年9月—2012年3月我院符合纳入标准的40例难治性UC患者Ⅰ期RP-IPAA术前、Ⅱ期造口还纳术前、Ⅱ期造口还纳术后12个月进行中文版炎症性肠病生活质量问卷(IBDQ)调查,与40例健康人群相比较,分析RP-IPAA术对难治性UC患者生活质量的影响。结果难治性UC患者Ⅰ期RP-IPAA术前总体生活质量及4个维度得分均较健康人群低,差异有统计学意义(P<0.01);除总体生活质量和社会能力外,Ⅱ期回肠造口还纳术前,肠道症状、全身症状及情感能力维度得分与健康人群相比差异无统计学意义(P>0.05);Ⅱ期造口还纳术后12个月总体生活质量及4个维度得分均接近于健康人群,差异无统计学意义(P>0.05)。不同手术时期,患者总体生活质量及各维度变化趋势不同,其中Ⅰ期术后肠道症状、Ⅱ期术后社会能力改善最为显著。结论二期行RP-IPAA术可明显改善难治性UC患者的生活质量,术后12个月患者生活质量接近于健康人群;应根据不同手术期生活质量变化情况提供针对性治疗护理。

Objective To evaluate the effects of two - stage restorative proctocolectomy with ileal pouch - anal anasto- mosis （RP -IPAA） on quality of life （QoL） in patients with refractory ulcerative colitis （UC） . Methods 40 patients with re- fractory UC, who met the inclusion criteria and underwent RP - IPAA surgery between September 2008 and March 2012, were included in our study. The Chinese version of the Inflammatory Bowel Disease Quality of Life Questionnaire （ IBDQ ） survey was administrated before the first stage of RP - IPAA, before the second stage of ileostomy closure, and 12 months after ileostomy closure, respectively. The effects of the surgery on QoL were analysed, and data were compared with the reference values of 40 healthy people. Results Before the first stage of RP - IPAA, the scores of the overall QoL and its four dimensions in refractory UC patients were significantly lower than those of the healthy people （ P 〈 0.01 ） . Before the second stage of ileostomy closure, no significant difference between the patients and the healthy population was noted in intestinal symptoms, constitutional symptoms and emotional capacity, except for the overall QoL and social skills （ P 〉 0.05 ） . At 12 months after ileostomy closure, there was no significant difference in the scores of the overall QoL and its four dimensions between the 40 patients and the healthy population （ P 〉 0.05 ） . The trends of the overall QoL and its four dimensions were diverse in different surgical periods, of which intestinal symptoms after the first stage surgery and social competence after ileostomy closure were most significantly improved. Conclusion Two - stage RP - IPAA surgery can significantly improve the QoL of refractory UC patients ; and the level of QoL in patients at 12 months after surgery is close to that of healthy population. Targeted care and treatment measures should be provided based on the change of QoL in different operative periods.