经腹会阴联合切除术与低位前切除术对直肠癌患者生活质量影响的探讨

摘要

目的：分析比较经腹会阴联合切除术（abdominoperineal resection， APR）与低位前切除术（low anterior resection， LAR）两种术式对直肠癌患者术后生活质量的影响。方法回顾性分析2007年1月至2013年12月间在本院接受APR和LAR手术的低位直肠癌患者的临床资料。采用结直肠癌生活质量测量量表29（Quality of life questionnaire－Colorectal Cancer 29， QLQ－CR29）对APR组和LAR组患者的生活质量进行比较。结果最终有完整问卷的患者有164例（APR组50例，LAR组114例）。 APR组患者的平均年龄显著高于LAR组，APR组患者肿瘤下缘距齿线距离显著短于LAR组（P＜0．001）。两组患者在性别、体质指数、ASA评分及术前临床分期方面均无统计学差异。排尿情况，APR组在术后1个月明显优于LAR组，术后6、12个月两组无差异。大便情况，术后1个月APR组明显优于LAR组，术后6个月两组无明显差异，但术后12个月LAR明显优于APR组。主观感受术后1、6个月LAR组明显优于APR组，但术后12个月，两组无明显差异。结论 APR术式优势在于术后短期内排尿、排便，而LAR术的优势也在于术后短期内主观感觉方面。低位直肠癌患者行APR手术后长期生活质量不逊于LAR术式。%Objective To evaluate and compare quality of life between abdominoperineal resection (APR) and low anterior resection (LAR) in the patients with low rectal cancer. Methods Clinical data of the patients with LAR or APR for low rectal cancer in our hospital from January 2007 to December 2013 were retrospectively analyzed. Quality of life questionnaire-Colorectal Cancer 29 (QLQ-CR29) scale was used to assess the quality of life after APR and LAR. The quality of life was compared between LAR and APR groups. Results A total of 164 cases including 50 in the APR group and 114 in the LAR group finished the questionnaire survey. The mean age was significantly older , the distance from the lower edge of the tumor above the dentate line was significantly shorter in the APR group than those in the LAR group. There were no significant differences in gender, body mass index, preoperative American Society of Anesthesiologists score, clinical tumor staging between the two groups. The patients in the APR group had significantly better scores of urination and defecation at postoperative 1 month than those in the LAR group , but no differences were found at postoperative 6 months between the two groups , moreover the score of defecation was significantly better at postoperative 12 months in the LAR group than that in the APR group. The score of subjective feelings at postoperative 1 and 6 months were significantly worse in the APR groups than those in the LAR group, but no difference was found at postoperative 12 months. Conclusions As for post-operative short-term quality of life , APR is superior in urination and defecation , while LAR in subjective feelings. Nevertheless APR is not inferior to LAR in long-term quality of life in rectal cancer.