直肠癌保肛术后短期生活质量研究现状

Current status of research on short-term quality of life after sphincteric-saving surgery in rectal cancer patients

保肛手术是目前中低位直肠癌治疗中的热点。尽管保肛手术保留了肠道的解剖连续性,但患者术后功能及生活质量能否达到满意的效果仍有待进一步证实。现有的研究显示,保肛患者术后1个月多项功能及症状评分较术前明显恶化,而在3~6个月内逐渐恢复并接近术前水平,在1年左右基本稳定。患者术后功能变化情况与患者相关因素、肿瘤因素、治疗相关因素和术后并发症密切相关。(1)在患者相关因素中,年龄<70岁患者的角色功能、性功能相对较差,而认知功能、躯体功能则相对较好;男性患者在性功能、社会功能下降相对明显。(2)在肿瘤相关因素中,肿瘤位置较低的患者排粪功能较差,进展期较早期肿瘤患者额外增加化疗治疗及副作用影响。(3)在治疗相关因素中,患者经括约肌间切除术后的排粪功能、社会功能、角色功能下降相对明显;预防性造口使患者角色功能、身体形象、性兴趣恶化;放化疗治疗使患者味觉改变、胸闷等化疗相关症状评分恶化。(4)在术后并发症方面,吻合口漏患者术后排粪功能、心理状态在近期明显下降;重度直肠前切综合征及泌尿生殖系统障碍患者的总健康评分,躯体功能、角色功能和社交功能下降。总体来说,保肛手术患者的短期生活质量改变是可接受的。在该阶段应对患者进行针对性地干预和治疗,以期提高患者术后的功能及生活质量。另外,由于多种因素同时影响患者生活质量,研究者对术后生活质量评分的解读存在一定困难,需要更具体及全面的评价工具来评价直肠癌术后的生活质量。

Sphincteric-saving surgery(SSS)is currently a hot spot in the treatment of mid-low rectal cancer.Although it preserves the anatomical continuity of the colon and anus,the postoperative functional outcomes and quality of life(QOL)remains to be confirmed.Current studies have shown that quality of life worsens at the first month after surgery,improves within 3-6 months,and stabilizes at about 1 year.The QOL was associated with patient-related factors,tumor-related factors,treatment-related factors and postoperative complications.For patient-related factors,younger patients have worse role function and sexual function but better cognitive function and physical function.Male patients deteriorate significantly in sexual and social function.For tumor-related factors,patients with lower rectal cancer have poorer defecation function.Those with advanced rectal cancer are more likely to suffer from side-effects related to chemotherapy.For treatment-related factors,patients undergoing intersphincteric resection have worse role function,body image and sexual interest.Preventive ileostomy results in the deterioration of role function,body image and sexual interest.Chemotherapy causes taste changes and chest pain.For postoperative complication,patients with anastomotic leakage have worse bowel function and psychological state.Patients with major low anterior resection syndrome and genitourinary dysfunction have worse global health score,social function and role function.In conclusion,short-term quality of life after sphincteric-saving surgery is acceptable.To improve QOL,specific intervention and guidance should be given to patients in this stage.Meanwhile,since many factors influence the quality of life simultaneously,researchers are confused about the questionnaire outcomes.Therefore,more specific and comprehensive tools are needed to evaluate QQL after sphincteric-saving surgery.