Segmental vs. extended colectomy:: Measurable differences in morbidity, function, and quality of life
Segmental vs. extended colectomy:: Measurable differences in morbidity, function, and quality of life
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DOI：
10.1007/s10350-008-9325-1
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发表时间：
2008-07-01
影响因子：
3.9
通讯作者：
Harrington, Jeffrey
中科院分区：
文献类型：
--
作者：
You, Y. Nancy;Chua, Heidi K.;Harrington, Jeffrey
目的：结肠协调粪便排泄，同时重新吸收多余的液体。延长结肠切除术可消除同步性疾病并预防异时性疾病，但与节段性切除术相比，可能在更大程度上对肠功能和健康相关生活质量产生不利影响。本研究考察了不同程度结肠切除术后的短期发病率和长期功能及生活质量。方法：回顾1991年至2003年期间接受扩大切除术（n=201例，回肠b状结肠次全切除术或回肠直肠吻合术的全腹结肠切除术）和部分结肠切除术（n=321例）的患者的围手术期结果，并使用机构问卷调查和经过验证的生活质量仪器调查肠道功能和生活质量（有效率：70%）。结果：扩大切除的最常见适应症是多发息肉，节段性切除的最常见适应症是单一恶性肿瘤。节段切除术后无并发症率为75.4%，回肠乙状结肠吻合术为42.8%，回肠吻合术为60%。尽管有相当大的饮食限制（55.6%）和药物使用（19.6%），节段切除后的平均每日大便次数为2次，回肠乙状结肠吻合术后为4次，回肠直肠吻合术后为5次。患者术前社交活动（31.5%）、家务（20.4%）、娱乐（31.5%）、回肠吻合术后旅行（42.6%）受到限制的比例显著。节段切除、回肠乙状结肠吻合术和回直肠吻合术后的总体生活质量分别为98.5、94.9和91.2。结论：可测量的长期肠功能和生活质量的损害观察到延长和部分切除后。患者相关结果的相对差异应考虑到延长切除对个体患者的临床益处。
PURPOSE: The colon coordinates fecal elimination while reabsorbing excess fluid. Extended colonic resection removes synchronous and prevents metachronous disease but may adversely alter bowel function and health-related quality of life to a greater degree than segmental resection. This study examined the short-term morbidity and long-term function and quality of life after colon resections of different extents.METHODS: Patients undergoing extended resections (n=201, subtotal colectomy with ileosigmoid or total abdominal colectomy with ileorectal anastomosis) and segmental colonic resections (n=321) during 1991 to 2003 were reviewed for perioperative outcomes and surveyed for bowel function and quality of life using an institutional questionnaire and a validated quality of life instrument (response rate: 70 percent).RESULTS: The most common indication for extended resections was multiple polyps, and for segmental resections, single malignancy. The complication-free rate was 75.4 percent after segmental resections, 42.8 percent after ileosigmoid anastomosis, and 60 percent after ileorectal anastomosis. Median daily stool frequency was two after segmental resections, four after ileosigmoid anastomosis, and five after ileorectal anastomosis, despite considerable dietary restrictions (55.6 percent) and medication use (19.6 percent daily) after ileorectal anastomosis. Significant proportions of patients felt restricted from preoperative social activity (31.5 percent), housework (20.4 percent), recreation (31.5 percent), and travel (42.6 percent) after ileorectal anastomosis. The overall quality of life after segmental resection, ileosigmoid anastomosis, and ileorectal anastomosis was 98.5, 94.9, and 91.2, respectively.CONCLUSIONS: Measurable compromises in long-term bowel function and quality of life were observed after extended vs. segmental resections. The relative differences in patient-related outcomes should be deliberated against the clinical benefits of extended resection for the individual patient.