腹腔镜直肠全系膜切除术对中青年低位直肠癌患者的生活质量和心理状况影响

The effect of laparoscopic rectal total mesorectal excision on the quality of life and psychological status of young and middle-aged patients with low rectal cancer

目的探讨腹腔镜下直肠全系膜切除术对中青年患者心理状况和生活质量的影响。方法选择2013年1月至2015年1月于本院接受腹腔镜下直肠全系膜切除术(total mesorectal excision,TME)的45例中青年低位直肠癌患者为研究对象,均以入院当天结果为基准,采用汉密顿焦虑量表(Hamilton anxiety scale,HAMA)评估手术当天、术后1个月及术后6个月的心理状况,采用癌症患者生命质量测定量表(European organization for research and treatment of cancer QLQ-C30,EORTC QLQ-C30)评估术后1个月、术后3个月及术后6个月的生活质量。结果心理状况方面,手术当天HAMA的焦虑心境、恐惧评分均显著增高(均P<0.05);术后6个月,焦虑心境、抑郁心境、恐惧及认知功能评分均有改善(均P<0.05)。生活质量方面,术后1个月及术后3个月总健康评分、情绪功能、社会功能均有明显改善,术后6个月总健康评分、躯体功能、情绪功能、社会功能均有明显改善,术后的三个时间点疲倦、恶心及呕吐、失眠、气促、食欲丧失症状均有显著改善(均P<0.05)。结论接受腹腔镜下TME的患者在手术当天心理波动较大,在术后6个月可有显著改善;在生活质量方面,术后1个月总健康评分即开始有显著改善。生活质量和心理状况的评估结果可为改善患者术后生活状态提供一定的参考依据。

Objective To investigate the effect of laparoscopic rectal total mesorectal excision on the mental status and quality of life of the young and middle-aged patients with low rectal caner. Methods 45 cases of young and middle-aged patients with rectal cancer who received laparoscopic total mesorectal excision（TME） in our hospital from January 2013 to January 2015 were recruited as research subject. Baseline referred to the day of admission. Patients were assessed on the day of surgery,and 1 month,and 6 montsh after the surgery regarding their psychological status using the Hamilton Anxiety Scale（Hamilton anxiety scale,HAMA）. Quality of life was assessed 1 month,3 months,and 6 months after the surgery using scale of the quality of life of cancer patients（European organization for research and treatment of cancer QLQ-C30,EORTC QLQ-C30）. Results In terms of mental status,HAMA anxiety and fear scores were significantly increased on the day of operation（all P 〈0.05）. Anxiety mood,depressive mood,fear and cognitive function scores improved at 6 months after operation（all P〈 0.05）. Total health score,emotional function,social function 1 months and3 months after the operation. Total health score,physical function,emotional function and social function improved significantly 6 months after after surgery. Fatigue,nausea and vomiting,insomnia loss of appetite,shortness of breath,symptoms were significantly improved at all time points after urgery（P〈 0.05）. Conclusion The patients undergoing laparoscopic TME had great psychological fluctuation on the day of surgery,which improved significantly 6 months after surgery. In terms of quality of life,the total health score 1 month after surgery improved significantly. The results can provide some information for improving the postoperative quality of life of these patients.