Tsunoda Akira, Tsunoda Yuko, Narita Kazuhiro, Watanabe Makoto, Nakao Kentaro, Kusano Mitsuo
Department of General and Gastroenterological Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan.
Dis Colon Rectum. 2008 Feb;51(2):218-22. doi: 10.1007/s10350-007-9101-7. Epub 2008 Jan 3.
Low anterior resection has become the operation of choice for mid rectal or low rectal cancer. A defunctioning stoma is routinely created at some centers to decrease the risk of leakage requiring surgical intervention. This study was designed to evaluate the quality of life in patients undergoing low anterior resection with a temporary ileostomy.
A prospective longitudinal study was conducted in 22 patients with rectal cancer who underwent low anterior resection with a loop ileostomy. Quality of life was assessed by using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR38 questionnaires. Twenty-five patients who underwent high anterior resection for rectosigmoid cancer were studied concurrently to evaluate the impact of major colorectal resection without a stoma.
Patients' scores on the quality of life questionnaires generally improved after high anterior resection; however, for patients who underwent low anterior resection, the scores for physical and role functioning before ileostomy closure were worse than the preoperative values. The scores on the quality of life questionnaires generally improved after ileostomy closure. Ileostomy closure required a short hospital stay and was rarely associated with complications.
Patients who underwent low anterior resection with ileostomy had significant reductions in physical and role functioning, which apparently improved after ileostomy closure. Similar declines in these quality of life variables were not found in patients who underwent high anterior resection. A temporary ileostomy should be created in selected patients with the highest risk of anastomotic leakage. Increased resources for not only surgical care but also for stoma therapy are necessary for patients who undergo low anterior resection with a temporary ileostomy.
低位前切除术已成为中低位直肠癌的首选术式。在一些中心，常规会做一个转流性造口以降低需手术干预的渗漏风险。本研究旨在评估接受低位前切除术并带有临时回肠造口术患者的生活质量。
对22例行低位前切除术并带有袢式回肠造口术的直肠癌患者进行了一项前瞻性纵向研究。采用欧洲癌症研究与治疗组织的QLQ-C30和QLQ-CR38问卷评估生活质量。同时对25例行乙状结肠癌高位前切除术的患者进行研究，以评估无造口的大肠大手术的影响。
高位前切除术后患者生活质量问卷得分总体有所改善；然而，对于接受低位前切除术的患者，回肠造口关闭前的身体和角色功能得分比术前值更差。回肠造口关闭后，生活质量问卷得分总体有所改善。回肠造口关闭所需住院时间短，且很少伴有并发症。
接受低位前切除术并行回肠造口术的患者身体和角色功能显著下降，回肠造口关闭后明显改善。在接受高位前切除术的患者中未发现这些生活质量变量有类似下降情况。对于吻合口漏风险最高的特定患者应做临时回肠造口。对于接受低位前切除术并行临时回肠造口术的患者，不仅手术护理而且造口治疗都需要增加资源。
