老年直肠癌患者永久性结肠造口术后生存质量的影响因素探究

Influencing factors of quality of life in elderly patients with rectal cancer after permanent colostomy

目的探讨老年直肠癌患者永久性结肠造口术后生存质量的影响因素。方法选取2017年1月至2018年12月53例于中南大学湘雅医学院附属海口医院行永久性结肠造口术的老年直肠癌患者为研究对象,采用世界卫生组织生存质量测定量表简表(World Health Organization quality of life scale-brief form questionnaire,WHOQOL-BREF)分析患者手术前后生存质量的变化情况,并筛选患者术后生存质量的影响因素。结果老年直肠癌患者造口术后1个月和3个月WHOQOL-BREF的生理状况、心理状况、社会关系维度评分及总分均显著低于术前(均P<0.05)。高中及以上文化程度、已婚、家庭人均月收入>4000元、肿瘤TNM分期Ⅰ期、无直肠癌家族史、无造口并发症、高自我效能患者术后3个月WHOQOL-BREF总分均显著高于小学及初中文化程度、离异/丧偶/未婚、家庭人均月收入<2000元、肿瘤TNM分期Ⅱ期与Ⅲ期、有直肠癌家族史、无造口并发症、低自我效能者(均P<0.05)。多元线性回归分析结果表明,家庭人均月收入、造口并发症、造口自我效能量表(stoma self-efficacy scale,SSES)总分均为老年直肠癌患者永久性结肠造口术后3个月生存质量的独立影响因素(均P<0.05),家庭人均月收入越高、无造口并发症、SSES总分越高,患者术后3个月WHOQOL-BREF总分越高。结论老年直肠癌患者永久性结肠造口术后3个月内的生存质量显著降低,家庭收入越高、有造口并发症、自我效能感越强,患者术后3个月的生存质量越高。

Objective To analyze the influencing factors of quality of life in elderly patients with rectal cancer after permanent colostomy.Method Fifty-three elderly patients with rectal cancer who underwent permanent colostomy in Haikou Hospital Affiliated to Xiangya Medical College of Central South University from January 2017 to December 2018 were enrolled for the study.The changes of quality of life after operation were analyzed through World Health Organization quality of life scale-brief form questionnaire(WHOQOL-BREF),and the influencing factors of quality of life were screened.Result The scores of physiological,psychological and social relations of WHOQOL-BREF at 1 month and 3 months after operation were significantly higher than those before operation(all P<0.05).The total scores of WHOQOL-BREF in patients with high school and above education level,married,average income per person in family>4000 yuan,no family history of rectal cancer,stoma complications and high self-efficacy at 3 months after operation were significantly higher than those with primary and junior high school education,divorce/widow/unmarried,average income per person in family<2000 yuan,non-rectal cancer families,no stoma complications and low self-efficacy(all P<0.05).Multivariate linear regression analysis showed that average income per person in family,stoma complications and total score of stoma self-efficacy scale(SSES)were the independent factors of quality of life at 3 months after operation(all P<0.05).Specifically,the higher the average monthly family income,developing stoma complications,the higher total score of SSES,the higher total score of WHOQOL-BREF scale at 3 months after operation.Conclusion The quality of life of elderly patients with rectal cancer significantly decreased within 3 months after permanent colostomy.The higher the average monthly family income,developing stoma complications,the stronger the self-efficacy,the higher total score of WHOQOL-BREF at 3 months after operation.