经肛门切除直肠息肉和癌后的功能及生活质量

Function and quality of life after transanal excision of rectal polyps and cancers.

作者信息

Fenech Darlene S, Takahashi Takeshi, Liu Maria, Spencer Leia, Swallow Carol J, Cohen Zane, Macrae Helen M, McLeod Robin S

机构信息

Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.

出版信息

Dis Colon Rectum. 2007 May;50(5):598-603. doi: 10.1007/s10350-006-0865-y.

DOI:10.1007/s10350-006-0865-y

PMID:17309002

Abstract

PURPOSE

The purpose of this study was to determine the functional outcomes and health-related quality of life of patients after transanal excision of rectal cancers or polyps and to assess the relationship between functional outcomes and health-related quality of life.

METHODS

All patients having a transanal excision at the Mount Sinai Hospital from 1989 to 2002 were included if the indication for surgery was a benign or malignant neoplasm. Physician charts were reviewed, and patients and their physicians were contacted to obtain follow-up information. Continence was assessed by using the Continence Score described by Jorge and Wexner and the Fecal Incontinence Quality of Life instrument by Rockwood and Lowry.

RESULTS

Eighty-two patients fit the inclusion criteria (42 males; mean age, 71 +/- 13.7 years). Of these, 29 had villous adenomas, 2 had carcinoids, and 1 had a hyperplastic polyp. Fifty had cancers, including 34 with T1, 14 with T2, and 2 with T3 cancers. Seven patients had a low anterior resection or abdominoperineal resection within two months of transanal excision because of advanced features of cancer. Five patients had salvage abdominoperineal resections or low anterior resections for local recurrences. Five patients died of rectal cancer (including 3 who had salvage surgery) and an additional seven patients died of other causes. Functional results were assessed in 58 of 61 eligible patients. The mean Continence Score postoperatively was 3.5 +/- 3.9 compared with 2.4 +/- 3.7 preoperatively (P = 0.03). The mean Fecal Incontinence Quality of Life scores after surgery in all patients were 3.9 +/- 0.3, 3.6 +/- 0.6, 3.7 +/- 0.3, 3.7 +/- 0.6 in the domains of lifestyle, coping, depression, and embarrassment, respectively, after surgery, indicating high quality of life. Using Spearman's correlation, we found that the continence scores after surgery correlated well with the Fecal Incontinence Quality of Life scores. In the domains of lifestyle (Spearman's correlation = -0.69), coping and behavior (Spearman's correlation = -0.7), and embarrassment (Spearman's correlation = -0.61) but did not correlate well with the domain of depression (Spearman's correlation = -0.17).

CONCLUSIONS

Although functional results are worsened in a minority of patients after transanal excision, quality of life is high in the majority of patients.

摘要

目的

本研究旨在确定直肠癌或息肉经肛门切除术后患者的功能结局及与健康相关的生活质量，并评估功能结局与健康相关生活质量之间的关系。

方法

纳入1989年至2002年在西奈山医院接受经肛门切除术的所有患者，手术指征为良性或恶性肿瘤。查阅医师病历，并联系患者及其医师以获取随访信息。采用Jorge和Wexner描述的控便评分以及Rockwood和Lowry的大便失禁生活质量量表评估控便情况。

结果

82例患者符合纳入标准（42例男性；平均年龄71±13.7岁）。其中，29例患有绒毛状腺瘤，2例患有类癌，1例患有增生性息肉。50例患有癌症，包括34例T1期、14例T2期和2例T3期癌症。7例患者因癌症进展在经肛门切除术后两个月内接受了低位前切除术或腹会阴联合切除术。5例患者因局部复发接受了挽救性腹会阴联合切除术或低位前切除术。5例患者死于直肠癌（包括3例接受挽救性手术的患者），另外7例患者死于其他原因。对61例符合条件的患者中的58例进行了功能结果评估。术后控便评分平均为3.5±3.9，术前为2.4±3.7（P = 0.03）。所有患者术后生活方式、应对、抑郁和尴尬领域的大便失禁生活质量评分分别为3.9±0.3、3.6±0.6、3.7±0.3、3.7±0.6，表明生活质量较高。采用Spearman相关性分析，我们发现术后控便评分与大便失禁生活质量评分相关性良好。在生活方式领域（Spearman相关性=-0.69）、应对与行为领域（Spearman相关性=-0.7）和尴尬领域（Spearman相关性=-0.61）相关性良好，但与抑郁领域相关性不佳（Spearman相关性=-0.17）。