Polle S W, Dunker M S, Slors J F M, Sprangers M A, Cuesta M A, Gouma D J, Bemelman W A
Department of Surgery, Academic Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
Surg Endosc. 2007 Aug;21(8):1301-7. doi: 10.1007/s00464-007-9294-9. Epub 2007 May 24.
This study aimed to compare quality of life (QOL), functional outcome, body image, and cosmesis after hand-assisted laparoscopic (LRP) versus open restorative proctocolectomy (ORP). The potential long-term advantages of LRP over ORP remain to be determined. The most likely advantage of LRP is the superior cosmetic result. It is, however, unclear whether the size and location of incisions affect body image and QOL.
In a previously conducted randomized trial comparing LRP with ORP, 60 patients were prospectively evaluated. The primary end points were body image and cosmesis. The secondary end points were morbidity, QOL, and functional outcome. A body image questionnaire was used to evaluate body image and cosmesis. The Short Form-36 Health Survey and the Gastrointestinal Quality of Life Inventory were used to assess QOL. Body image and QOL also were assessed preoperatively.
A total of 53 patients completed the QOL and functional outcome questionnaires. There were no differences in functional outcome, morbidity, or QOL between LRP and ORP. At a median of 2.7 years after surgery, 46 patients returned the questionnaires regarding body image, cosmesis, and morbidity. The body image and cosmesis scores of female patients were significantly higher in the LRP group than in the ORP group (body image, 17.4 vs 14.9; cosmesis, 19.1 vs 13.0, respectively). The female patients in the ORP group had significantly lower body image scores than the male patients (14.9 vs 18.3).
This study is the first to show that ORP has a negative impact on body image and cosmesis as compared with LRP. Functional outcome, QOL, and morbidity are similar for the two approaches. The advantages of a long-lasting improved body image and cosmesis for this relatively young patient population may compensate for the longer operating times and higher costs, particularly for women.
本研究旨在比较手辅助腹腔镜根治性直肠切除术（LRP）与开放性根治性直肠切除术（ORP）后的生活质量（QOL）、功能结局、身体形象和美容效果。LRP相对于ORP的潜在长期优势尚待确定。LRP最可能的优势是美容效果更佳。然而，切口的大小和位置是否会影响身体形象和生活质量尚不清楚。
在之前一项比较LRP与ORP的随机试验中，对60例患者进行了前瞻性评估。主要终点是身体形象和美容效果。次要终点是发病率、生活质量和功能结局。使用身体形象问卷评估身体形象和美容效果。采用简短健康调查问卷-36和胃肠道生活质量量表评估生活质量。术前也对身体形象和生活质量进行了评估。
共有53例患者完成了生活质量和功能结局问卷。LRP组与ORP组在功能结局、发病率或生活质量方面无差异。术后中位2.7年时，46例患者返回了关于身体形象、美容效果和发病率的问卷。LRP组女性患者的身体形象和美容效果评分显著高于ORP组（身体形象评分分别为17.4和14.9；美容效果评分分别为19.1和13.0）。ORP组女性患者的身体形象评分显著低于男性患者（14.9和18.3）。
本研究首次表明，与LRP相比，ORP对身体形象和美容效果有负面影响。两种手术方式的功能结局、生活质量和发病率相似。对于这一相对年轻的患者群体，长期改善身体形象和美容效果的优势可能弥补手术时间较长和费用较高的问题，尤其是对女性而言。
