Ohtsuka T, Yamaguchi K, Chijiiwa K, Kinukawa N, Tanaka M
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 812-8582, Fukuoka, Japan.
Am J Surg. 2001 Sep;182(3):230-6. doi: 10.1016/s0002-9610(01)00709-7.
With increasing numbers of long-term survivors after pylorus-preserving pancreatoduodenectomy (PPPD), postoperative quality of life (QOL) has become a great concern. However, few reports are available on data of the postoperative changes in QOL after PPPD.
A total of 20 patients were studied regarding QOL before and at short term (within 2 months), intermediate term (6 months), and long term (1 year) after PPPD, using a questionnaire. The questionnaire consisted of 13 physical and 10 psychosocial items. The medical records were also reviewed to evaluate objective nutritional status. Factors predicting delayed recovery of QOL were examined at intermediate term by univariate and multivariate analyses.
Overall and physical QOL scores returned to the preoperative level at intermediate term after PPPD, showing parallel changes with the objective nutritional status. However, the scores of psychosocial condition, which reflected the patient's mental health, remained low even at long term. QOL scores at intermediate term in patients with pancreatic carcinoma were significantly lower than those with other diseases. Univariate analysis showed that preoperative body weight loss, impaired preoperative pancreatic exocrine function, long operative time, intraoperative radiotherapy, pancreatic carcinoma, and postoperative diarrhea were factors predicting the delayed recovery of QOL. Multivariate analysis revealed that preoperative pancreatic exocrine function significantly affected the delayed recovery of QOL.
Preoperative supplement of pancreatic enzymes together with perioperative mental care would improve QOL at long term after PPPD.
随着保留幽门胰十二指肠切除术（PPPD）后长期存活患者数量的增加，术后生活质量（QOL）已成为备受关注的问题。然而，关于PPPD术后生活质量变化数据的报道较少。
使用问卷调查了20例患者在PPPD术前以及术后短期（2个月内）、中期（6个月）和长期（1年）的生活质量。问卷包括13项身体方面和10项心理社会方面的条目。还查阅了病历以评估客观营养状况。通过单因素和多因素分析研究中期生活质量延迟恢复的预测因素。
PPPD术后中期，总体生活质量和身体生活质量评分恢复到术前水平，与客观营养状况呈现平行变化。然而，反映患者心理健康的心理社会状况评分即使在长期也仍然较低。胰腺癌患者中期的生活质量评分显著低于其他疾病患者。单因素分析显示，术前体重减轻、术前胰腺外分泌功能受损、手术时间长、术中放疗、胰腺癌和术后腹泻是生活质量延迟恢复的预测因素。多因素分析表明，术前胰腺外分泌功能显著影响生活质量的延迟恢复。
术前补充胰酶并结合围手术期心理护理可改善PPPD术后长期的生活质量。
