Schmidt C, Bestmann B, Lindemann H, Küchler T, Löhnert M, Kremer B
Klinik für Allgemeine Chirurgie und Thoraxchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel.
Zentralbl Chir. 2005 Oct;130(5):393-9. doi: 10.1055/s-2005-836878.
Previous studies have suggested that sexuality following surgery for rectal cancer is better in women than in men and differs with type of surgery in terms of impact on Quality of Life. However, the findings were inconsistent. The aim of the presented study was to address these issues.
570 patients that had undergone surgery for rectal cancer in our department from 1992 to 1999 were included. After determination of survival status questionnaires on Quality of Life were sent to 370 patients one to two years post surgery. We analysed data from 215 patients of which 103 were female and 112 male. 248 patients died during the time observed. Statistical analysis was done with descriptive methods, Kaplan-Meier analysis (log rank test), T-test and analysis of variance using SPSS 11.0 for Windows.
Significant differences were seen in symptom scales between men and women. Women scored higher for distress through medical treatment and had higher values for insomnia, fatigue and constipation. Both sexes had impaired sexual life but men had significantly higher values and felt more distressed by the impairment of sexuality than women. For patients receiving abdominoperineal resection sexuality was most impaired. Anterior resection with pouch had a detrimental effect on diarrhoea and treatment strain.
The study showed that sexuality is influenced by gender and type of surgery and impacts Quality of Life after surgery for rectal cancer. Assessing quality of life with generic and specific instruments is helpful to determine differences between surgical procedures, age, gender, and adjuvant therapy where standard parameters such as survival have their limitations.
先前的研究表明，直肠癌手术后女性的性功能状况优于男性，并且不同手术类型对生活质量的影响存在差异。然而，研究结果并不一致。本研究的目的是解决这些问题。
纳入了1992年至1999年在我科接受直肠癌手术的570例患者。确定存活状态后，在术后一至两年向370例患者发送了生活质量问卷。我们分析了215例患者的数据，其中103例为女性，112例为男性。在观察期间有248例患者死亡。使用SPSS 11.0 for Windows软件，采用描述性方法、Kaplan-Meier分析（对数秩检验）、T检验和方差分析进行统计分析。
男性和女性在症状量表上存在显著差异。女性在医疗治疗引起的困扰方面得分更高，失眠、疲劳和便秘的得分也更高。两性的性生活均受到损害，但男性的得分显著更高，并且比女性更因性功能受损而感到困扰。接受腹会阴联合切除术的患者性功能受损最为严重。带贮袋的前切除术对腹泻和治疗负担有不利影响。
该研究表明，性功能受性别和手术类型的影响，并对直肠癌手术后的生活质量产生影响。使用通用和特定工具评估生活质量有助于确定手术方式、年龄、性别和辅助治疗之间的差异，而诸如生存率等标准参数存在局限性。
