Silva Mariane Messias Reis Lima, Junior Samuel Aguiar, de Aguiar Pastore Juliana, Santos Érica Maria Monteiro, de Oliveira Ferreira Fábio, Spencer Ranyell Matheus S B, Calsavara Vinicius F, Nakagawa Wilson Toshihiko, Lopes Ademar
Department of Colorectal Tumors, AC Camargo Cancer Center, Professor Antonio Prudente, 211, Sao Paulo, SP, 01509-900, Brazil.
Int J Colorectal Dis. 2018 Aug;33(8):1039-1045. doi: 10.1007/s00384-018-3044-4. Epub 2018 Apr 19.
Patients with cancer of the lower and middle rectum who are candidates for curative surgery often have negative opinions on definitive colostomy. The purpose of this study is to compare the quality of life (QoL) of patients who undergo standard treatment for rectal cancer with sphincter preservation or definitive colostomy.
A total of 125 patients with adenocarcinoma of the lower or middle rectum who underwent radical surgery with curative intent with a follow-up ≥ 1 year were recruited: 83 patients (group 1) were subjected to low anterior resection and low colorectal or coloanal anastomosis-thus preserving their sphincter-and 42 (group 2) were treated with abdominoperineal resection, followed by terminal definitive colostomy. QoL was assessed with the EORTC QLQ-C30 and QLQ-CR29 questionnaires.
Health and global quality of life were similar between groups; however, patients who underwent definitive colostomy had higher scores on the emotional (p value = 0.016) and cognitive function scales (p value = 0.017). Patients with sphincter preservation presented with more symptoms that were related to stool frequency (p value < 0.001), intestinal constipation (p value = 0.005), fecal incontinence (p value = 0.001), buttock pain (p value = 0.023), and nausea and vomiting (p value = 0.036), whereas patients with permanent colostomy had higher scores for dysuria (p value = 0.033).
Although global QoL scores did not differ between groups, patients who underwent definitive colostomy had significantly better functional and symptom scale scores, reflecting greater function with fewer symptoms.
适合进行根治性手术的中低位直肠癌患者对永久性结肠造口术往往持负面看法。本研究旨在比较接受保肛或永久性结肠造口术的直肠癌标准治疗患者的生活质量（QoL）。
共招募了125例中低位直肠腺癌患者，这些患者接受了根治性手术且随访时间≥1年：83例患者（第1组）接受了低位前切除术及低位结直肠或结肠肛管吻合术，从而保留了肛门括约肌；42例患者（第2组）接受了腹会阴联合切除术，随后进行永久性结肠造口术。使用欧洲癌症研究与治疗组织（EORTC）QLQ-C30和QLQ-CR29问卷评估生活质量。
两组患者的健康和总体生活质量相似；然而，接受永久性结肠造口术的患者在情感功能量表（p值=0.016）和认知功能量表（p值=0.017）上得分更高。保肛患者出现更多与排便频率相关的症状（p值<0.001）、肠道便秘（p值=0.005）、大便失禁（p值=0.001）、臀部疼痛（p值=0.023）以及恶心和呕吐（p值=0.036），而永久性结肠造口术患者的排尿困难得分更高（p值=0.033）。
尽管两组患者的总体生活质量得分没有差异，但接受永久性结肠造口术的患者在功能和症状量表上的得分明显更好，这反映出其功能更好且症状更少。
