Tariverdian Mirjam, Leowardi Christine, Hinz Ulf, Welsch Thilo, Schmidt Jan, Kienle Peter
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Inflamm Bowel Dis. 2007 Oct;13(10):1228-35. doi: 10.1002/ibd.20175.
Restorative proctocolectomy has become the surgical procedure of choice in patients with ulcerative colitis. Only smaller studies have compared postoperative to preoperative quality of life (QoL).
Patients with ulcerative colitis who had undergone restorative proctocolectomy at least 5 years before and who had filled out a disease-specific validated questionnaire (Gastrointestinal Quality of Life Index, GIQLI) prior to surgery (n = 128) were included into this follow-up study. Factors potentially influencing QoL at the time of operation were investigated with regard to pre- and postoperative QoL in univariate and multivariate analysis.
A total of 105 patients responded (82%). QoL at least 5 years after colectomy was significantly improved compared to the preoperative situation (109 versus 75). This improvement was evident in all 5 dimensions (P < 0.0001). The Colitis Activity Index (CAI) (P < 0.00001), a shorter duration of the disease (P < 0.05), and a 3-staged procedure (<0.001) were negatively correlated with preoperative QoL, whereas neoplasia (P < 0.001) was positively correlated. Colectomy was the reason for most of the increase in QoL. Ileostomy closure resulted in a further improvement in 3 of 5 dimensions but not in overall QoL. Uni- and multivariate analysis of the difference in QoL before and 5 years after colectomy revealed CAI, the type of operation (both P < 0.001), and neoplasia as significant factors (P < 0.05).
The patients in the worst clinical situation profit the most from restorative proctocolectomy.
全结直肠切除回肠储袋肛管吻合术已成为溃疡性结肠炎患者的首选手术方式。仅有一些规模较小的研究比较了术后与术前的生活质量（QoL）。
纳入至少在5年前接受过全结直肠切除回肠储袋肛管吻合术且在手术前填写了特定疾病有效问卷（胃肠道生活质量指数，GIQLI）的溃疡性结肠炎患者（n = 128）进行这项随访研究。在单因素和多因素分析中，就术前和术后的生活质量调查了可能影响手术时生活质量的因素。
共有105例患者作出回应（82%）。结肠切除术后至少5年的生活质量与术前相比有显著改善（109对75）。这种改善在所有5个维度均很明显（P < 0.0001）。结肠炎活动指数（CAI）（P < 0.00001）、疾病持续时间较短（P < 0.05）以及三阶段手术（<0.001）与术前生活质量呈负相关，而肿瘤形成（P < 0.001）呈正相关。结肠切除术是生活质量提高的主要原因。回肠造口关闭使5个维度中的3个维度进一步改善，但未使总体生活质量得到改善。对结肠切除术前和术后5年生活质量差异的单因素和多因素分析显示，CAI、手术类型（均P < 0.001）和肿瘤形成是显著因素（P < 0.05）。
临床状况最差的患者从全结直肠切除回肠储袋肛管吻合术中获益最大。
