A30 Department of Colorectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Tech Coloproctol. 2011 Jun;15(2):173-7. doi: 10.1007/s10151-011-0677-5. Epub 2011 Mar 23.
The recovery benefits of laparoscopy are traditionally believed to minimize the initial negative impact of surgery on early postoperative quality of life (QOL). We evaluate whether laparoscopic colectomy leads to recovery of QOL early after surgery and evaluate factors associated with the change in QOL.
Preoperative and early postoperative QOL data (SF-36) were prospectively accrued for patients undergoing laparoscopic colorectal resection (LCR) (2002-2009). Changes in postoperative QOL from preoperative values and effects of patient, disease, operation and postoperative outcomes on these changes were evaluated.
One hundred and sixty-six patients (female = 86) underwent LCR for cancer (n = 79), Crohn's disease (n = 24), diverticulitis (n = 38), and ulcerative colitis (n = 25) with complete SF-36 scores. Median age was 56.9 (range: 15-91) years, mean body mass index 27.4 ± 6.2 kg/m(2) with American Society of Anesthesiologists (ASA) class being II in 94 patients. Median operative time was 152.5 (range: 50-358) min; mean length of stay (LOS) 4.5 ± 3.3 days. At 4 weeks, the postoperative SF-36 physical component scale (PCS) continued to be lower than the preoperative PCS (41.8 ± 8.8 vs. 47.1 ± 9.4, P < 0.001), while the postoperative SF-36 mental component scale (MCS) was similar to the preoperative MCS (45.6 ± 10.2 vs. 46.1 ± 11.9, P = 0.17). Gender, age, operation, LOS, surgeon, ASA, BMI, complications, and readmission were not associated with a change in QOL from preoperative values. Cancer as an indication for surgery was associated with less improvement of MCS and PCS (P = 0.024 and 0.004, respectively).
Although patients who undergo LCR may have clinical evidence of healing at 4 weeks after surgery, QOL does not return to the preoperative level. This finding may help develop evidence-based recommendations pertaining to timing of return to full activity.
传统上认为腹腔镜手术的恢复益处可以将手术对术后早期生活质量（QOL）的负面影响降至最低。我们评估腹腔镜结肠切除术（LCR）是否会在手术后早期恢复 QOL，并评估与 QOL 变化相关的因素。
前瞻性收集 2002 年至 2009 年间接受腹腔镜结直肠切除术（LCR）的患者的术前和术后早期 QOL（SF-36）数据。评估术后 QOL 相对于术前值的变化以及患者、疾病、手术和术后结果对这些变化的影响。
166 例患者（女性=86 例）因癌症（n=79 例）、克罗恩病（n=24 例）、憩室炎（n=38 例）和溃疡性结肠炎（n=25 例）接受 LCR，SF-36 评分完整。中位年龄为 56.9（范围：15-91）岁，平均体重指数为 27.4±6.2kg/m²，94 例患者为美国麻醉医师协会（ASA）Ⅱ级。中位手术时间为 152.5（范围：50-358）min；平均住院时间（LOS）为 4.5±3.3 天。4 周时，术后 SF-36 生理成分量表（PCS）仍低于术前 PCS（41.8±8.8 vs. 47.1±9.4，P<0.001），而术后 SF-36 心理成分量表（MCS）与术前 MCS 相似（45.6±10.2 vs. 46.1±11.9，P=0.17）。性别、年龄、手术、LOS、外科医生、ASA、BMI、并发症和再入院与术前 QOL 无变化无关。手术指征为癌症与 MCS 和 PCS 的改善较少相关（P=0.024 和 0.004）。
尽管接受 LCR 的患者在手术后 4 周可能有临床愈合证据，但 QOL 并未恢复到术前水平。这一发现可能有助于制定与恢复正常活动时间相关的循证建议。
