Quality of life after surgery for rectal cancer
Quality of life after surgery for rectal cancer
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直肠癌手术后的生活质量
DOI：
10.1007/bf02238568
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发表时间：
1999
影响因子：
3.9
通讯作者：
R. Schiessel
中科院分区：
文献类型：
--
作者：
K. Renner;H. Rosen;G. Novi;N. Hölbling;R. Schiessel
永久性结肠造口术严重限制了患者的生活质量。除了治愈癌症外，保留括约肌功能是直肠癌手术的重要目标。方法：在一项前瞻性研究中，对每位直肠癌患者提供括约肌修复或“新括约肌”的概念进行了调查，并分析了该策略对肿瘤学结果、括约肌功能和生活质量的影响。结果：1992 ~ 1997年共纳入276例患者。261名患者接受了选择性手术，15名患者接受了直肠肿瘤的紧急手术。术后死亡率为4%。197例（75%）患者可以根治性切除（R0）。前切除术是最常见的手术（n=87），括约肌间切除术联合结肠肛管吻合术是低位肿瘤的首选方法（n=65）。腹部会阴切除术15例。13例患者通过动态股髂成形术立即恢复了括约肌功能，2例患者因出血需要紧急腹部会阴切除术。随访时间相对较短（中位36.4个月），在数据分析时显示局部复发率为8%。虽然根据Williams评分，术后尿失禁的结果令人满意，但主观生活质量和特定症状的评分显示，与前切除术相比，超低（结肠肛门）吻合术患者的结果明显更差。结论：我们的结论是，在选择性治疗性直肠癌手术中，如果采用所有现有的括约肌保留和恢复技术，永久性结肠造口是不必要的。然而，必须告知患者结肠肛管吻合术或新括约肌重建等手术可能产生的副作用，以避免严重的心理困难。
INTRODUCTION: A permanent colostomy is a serious limitation of the quality of life. Besides cure of cancer, preservation of sphincter function is an important goal of surgery for rectal cancer. METHODS: In a prospective study a concept offering every patient with rectal cancer either sphincter salvage or a “neosphincter” was investigated, and the impact of this strategy on oncologic results, sphincter function, and quality of life was analyzed. RESULTS: From 1992 to 1997, 276 patients were accepted for the study. Two hundred sixty-one patients had elective surgery, and 15 patients had emergency surgery for their rectal tumors. The postoperative mortality rate was 4 percent. A radical resection (R0) was possible in 197 patients (75 percent). Anterior resection was the most common procedure (n=87), and intersphincteric resection with coloanal anastomosis was the preferred method for low tumors (n=65). Abdominoperineal resection was necessary in 15 cases. Thirteen patients had an immediate restoration of sphincter function by means of a dynamic graciloplasty, and 2 patients needed emergency abdominoperineal resection for bleeding. The follow-up was relatively short (median, 36.4 months) at the time of data analysis and showed a local recurrence rate of 8 percent. Although postoperative continence according to the Williams score revealed satisfactory results, subjective quality of life and the scale for specific symptoms showed a significantly worse outcome in patients with ultralow (coloanal) anastomoses compared with those with anterior resection. CONCLUSIONS: We conclude that for elective curative surgery of rectal cancer, a permanent colostomy is not necessary provided all presently available techniques of sphincter salvage and restoration are applied. However, the patient has to be informed about possible side effects associated with surgical procedures such as coloanal anastomosis or neosphincter reconstruction, to avoid severe psychological difficulties.