直肠癌前切除术后生活质量及前切除综合征相关因素分析

Quality of life after anterior resection of rectal cancer and analysis of related factors of anterior resection syndrome

目的调查直肠癌前切除术后病人排便状况及生活质量,分析前切除综合征(ARS)的相关因素。方法 2010年5月~2016年5月因直肠癌行直肠前切除术后病人100例,病人填写低位ARS评分表(LARS评分表)、EORTC QLQ-C30(V3.0)生活质量量表,共获得完整资料85例。按照LARS评分表,将病人分为重度ARS、无/轻度ARS两组,比较两组病人的生活质量,综合分析相关因素。结果 ARS病人45例(52.9%),包括重度30例(35.3%),轻度15例(17.6%);ARS各症状的发生比率依次为里急后重(69.4%)>排便急迫(57.7%)>气体失禁(52.9%)>便频(42.4%)>稀便失禁(38.8%)>便秘(11.7%)。比较重度ARS、无/轻度ARS病人的EORTC QLQ-C30得分:在总体健康水平、所有功能维度(躯体功能、角色功能、情绪功能、认知功能、社会功能)、疲倦、腹泻方面的差异有统计学意义(P<0.05),重度ARS病人生活质量明显更差。年龄、肿瘤下缘距肛缘的距离、放疗是直肠癌前切除术后发生重度ARS的危险因素(P<0.05),但均不是独立危险因素(P>0.05)。结论直肠癌前切除术后病人的生活质量与ARS的发生密切相关,重度ARS病人生活质量较差。高龄、肿瘤位置较低以及曾接受放疗的病人更容易发生重度ARS。

Objective To investigate the defecation status and quality of life of patients after anterior resection of rectal cancer,and to analyze the related factors of anterior resection syndrome.Methods From May 2010 to May 2016,a total of 100 cases of patients with rectal cancer who underwent anterior rectal resection in Nanjing Hospital of TCM were followed up.Patients were asked to fill in LARS score form and EORTC qlq-c30(V3.0)quality of life scale.A total of 85 cases of complete data were obtained.According to LARS score table,patients were divided into two groups,major anterior resection syndrome and no/minor anterior resection syndrome,to compare the quality of life of two groups and analyze relevant factors.Results A total of 45/85 patients(52.9%)with anterior resection syndrome were diagnosed.These included 30/85 patients with major anterior resection syndrome(35.3%)and 15/85 patients with minor anterior resection syndrome(17.6%).The incidence rate of each symptom of preoperative resection syndrome was tenesmus(69.4%)> urgency of defecation(57.7%)> incontinence of gas(52.9%)> frequency of defecation(42.4%)> incontinence of liquid(38.8%)> constipation(11.7%).Compare major anterior resection syndrome,no/minor anterior resection syndrome in patients with EORTC QLQ C30-score:in the overall level of health,all the function dimension,physical function,role function,emotional function,cognitive function,social function,fatigue,diarrhea differences statistically significant(P<0.05),quality of life of patients with major anterior resection syndrome significantly worse.Age,the distance between the lower margin of the tumor and the anal margin,and radiotherapy were risk factors for major anterior resection syndrome after anterior resection of rectal cancer(P<0.05),but none of them were independent risk factors(P>0.05).Conclusion The quality of life of patients after anterior resection is closely related to the occurrence of anterior resection syndrome,and the quality of life of patients with major anterior resection syndrome is poor.Patients with advanced age,low anastomotic site and radiation therapy are more likely to develop major anterior resection syndrome.