Siassi Michael, Weiss Maren, Hohenberger Werner, Lösel Friedrich, Matzel Klaus
University Hospital of Erlangen, Department of General Surgery, Erlangen, Germany.
Dis Colon Rectum. 2009 Apr;52(4):662-8. doi: 10.1007/DCR.0b013e31819ecf2e.
Clinical factors, especially the presence of a stoma, have been presumed to be the major determinants of quality of life after colorectal surgery. We investigated the relative influence of other variables, e.g., patient's personality, sense of coherence, and coping strategies, to determine the validity of this long-held assumption.
We investigated 79 patients undergoing major colorectal surgery. Quality of Life was assessed with the Short Form-36 and Gastrointestinal Quality of Life Index questionnaires at three and 12 months postsurgery. Additionally, baseline psychologic data on personality and sense of coherence were assessed. The results were analyzed in both a bivariate manner and by multivariate hierarchical regression analysis.
In the bivariate analysis, clinical parameters had a small and temporary effect on quality of life, if any. In the multivariate model the character of the underlying disease and the presence of a stoma did not affect quality of life significantly. In contrast, emotional lability, extraversion, and sense of coherence had a strong and lasting influence, accounting for 49 percent of variance (Delta R2) for emotional quality of life, 22 percent for physical and 32 percent for disease-specific Quality of Life.
Personality exerts a strong and lasting effect on quality of life after colorectal surgery. This effect by far exceeds the influence of common clinical variables.
临床因素，尤其是造口的存在，一直被认为是结直肠手术后生活质量的主要决定因素。我们研究了其他变量的相对影响，例如患者的性格、连贯感和应对策略，以确定这一长期假设的有效性。
我们调查了79例接受大型结直肠手术的患者。在术后3个月和12个月时，使用简短健康调查问卷（Short Form-36）和胃肠道生活质量指数问卷评估生活质量。此外，还评估了关于性格和连贯感的基线心理数据。结果采用双变量分析和多元层次回归分析进行分析。
在双变量分析中，临床参数对生活质量的影响很小且是暂时的（如果有影响的话）。在多变量模型中，基础疾病的特征和造口的存在对生活质量没有显著影响。相比之下，情绪易变性、外向性和连贯感有强烈而持久的影响，分别占情绪生活质量方差的49%（ΔR2）、身体生活质量方差 的22%和特定疾病生活质量方差的32%。
性格对结直肠手术后的生活质量有强烈而持久的影响。这种影响远远超过常见临床变量的影响。
