直肠癌低位前切除患者术后肠道症状特点的研究

摘要

Objective To study the positive-operative characteristic of bowel symptoms for low anterior resection patients with rectal cancer .Method 119 low anterior resection patients with rectal cancer were investigated with the structured interview guide based on the dimensions of “symptom management theory” .Result The 6 most frequent-ly reported bowel symptoms were excessive flatus ,clustering ,urgency ,straining ,bowel frequency and anal pend-ant expansion . Periodic bowel movements was seen in 21patients (17 .6% ) .79 patients had surgery before six month .Among of them ,68 (86 .1% ) patients reported a significant improvement of bowel symptoms ,70 .5% (48/68) patients reported the improvement at least 6 months after surgery .The 119 patients were divided into three groups according to the length of postoperative period .There were significant differences in the positive rates of soi-ling ,straining and urgency among the three groups (P< 0 .05) .Pariwise comparisons between multiple samples were respectively conducted in the three bowel symptoms .Compared with the other two groups ,the positive rate of soiling in the 1 to 5 months group was significantly higher (P<0 .017) .The positive rate of urgency in the 1 to 5 months group was significantly higher than that in the 12 to 24 months group (P<0 .017) .The positive rate of straining in the 6 to 11 months group was significantly lower than that in the 12 to 24 months group(P<0 .017) . Negative psychological response was found among 87(73 .1% ) patients Conclusion For rectal cancer patients follow-ing low anterior resection surgery ,bowel symptoms can be improved with time .The 2 most improved symptoms are soiling and urgency .However ,bowel problems experienced by patients are ignored by healthcare professionals .%目的：探讨直肠癌低位前切除患者术后肠道症状的特点。方法使用建立在《症状管理理论》上的访谈大纲，对119例直肠癌低位前切除患者进行结构性访谈。结果术后最主要的6个肠道症状依次为过度排气、连续排便、便急、用力排便、便频和肛门坠胀。周期性排便者21例（17．6％）。术后6个月以上患者共79例，68例（86．1％）自述肠道症状显著改善，70．5％（48/68）的患者述至少6个月才发生这种改善。根据术后时间不同将119例研究对象分为3组，粪便泄露、排便用力和便急在3组间差异均有显著意义（P＜0．05）。接着对这三个肠道症状分别进行两两比较。结果显示：（1～5）个月组粪便泄露发生率显著高于（6～11）个月组和（12～24）个月组（P＜0．017），（1～5）个月组便急发生率显著高于（12～24）个月组（ P＜0．017），（6～11）个月组排便用力发生率显著低于（12～24）个月组（ P＜0．017）。87例（73．1％）患者出现消极心理反应。结论对于直肠癌低位前切除患者，术后肠道症状会随时间推移而逐渐改善，改善最明显的症状为粪便泄露和便急。患者术后肠道症状易被医护人员忽视。