Dowson H M, Cowie A S, Ballard K, Gage H, Rockall T A
Minimal Access Therapy Training Unit, Postgraduate Medical School, Manor Park, Guildford, Surrey, UK.
Colorectal Dis. 2008 Oct;10(8):757-68. doi: 10.1111/j.1463-1318.2008.01603.x.
To compare the health-related quality of life (HRQoL) of patients following laparoscopic and open colorectal surgery.
A systematic review was performed according to Quorum guidelines. Prospective studies comparing the HRQoL of patients after laparoscopic and open colorectal surgery were identified. The primary outcome measure was postoperative quality of life; performance status and cosmesis were secondary outcome measures.
23 studies were identified that satisfied the inclusion criteria; 18 assessed HRQoL, 4 performance status, and 3 cosmesis. It was not possible to perform a meta-analysis due to study heterogeneity. The studies reported outcomes for 2946 patients. The most frequent HRQoL instruments employed were SF-36, EORTC, and GIQLI. 6 studies, using a total of 12 separate measures, evaluated QoL during the first 3 post-operative months: 10 of these measures showed no significant difference, and 2 showed an improved HRQoL with laparoscopy. Twelve further studies evaluated HRQoL up to 5 years post-operatively: 9 showed no difference between the 2 groups, and 3 demonstrated a benefit for laparoscopy. Three of 4 studies assessing performance status on discharge, and all 3 studies assessing cosmesis, reported benefits with the laparoscopic approach.
The current evidence suggests there is no significant difference in HRQoL following laparoscopic and open colorectal surgery, although there is a lack of good quality data. There is a trend towards improved quality of life outcomes and performance status with laparoscopy in the early post-operative period. There is a need for further research, particularly assessing quality of life in the early post-operative period.
比较腹腔镜结直肠手术和开放结直肠手术后患者的健康相关生活质量（HRQoL）。
根据Quorum指南进行系统评价。纳入比较腹腔镜结直肠手术和开放结直肠手术后患者HRQoL的前瞻性研究。主要结局指标为术后生活质量；性能状态和美容效果为次要结局指标。
确定了23项符合纳入标准的研究；18项评估了HRQoL，4项评估了性能状态，3项评估了美容效果。由于研究的异质性，无法进行荟萃分析。这些研究报告了2946例患者的结局。使用最频繁的HRQoL工具是SF-36、欧洲癌症研究与治疗组织（EORTC）和胃肠道生活质量指数（GIQLI）。6项研究共使用12种独立测量方法，评估术后前3个月的生活质量：其中10种测量方法显示无显著差异，2种显示腹腔镜手术可改善HRQoL。另有12项研究评估了术后长达5年的HRQoL：9项显示两组之间无差异，3项表明腹腔镜手术有益。4项评估出院时性能状态的研究中有3项，以及所有3项评估美容效果的研究，均报告腹腔镜手术方法有益。
目前的证据表明，腹腔镜结直肠手术和开放结直肠手术后的HRQoL无显著差异，尽管缺乏高质量数据。在术后早期，腹腔镜手术有改善生活质量结局和性能状态的趋势。需要进一步研究，特别是评估术后早期的生活质量。
