Tong Guojun, Zhang Guiyang, Liu Jian, Zheng Zhaozheng, Chen Yan, Li Min, Zhong Yan, Niu Pingping, Xu Xuting
Department of Colorectal Surgery, Huzhou Central Hospital, Zhejiang, 313000, China.
Central Laboratory, Huzhou Central Hospital, Zhejiang, 313000, China.
BMC Surg. 2020 Mar 30;20(1):57. doi: 10.1186/s12893-020-00719-6.
Rectal cancer (RC) surgery often results in permanent colostomy, seriously limiting the quality of life (QOL) in patients in terms of bowel function. This study aimed to examine defecation function and QOL in RC patients who underwent non-ostomy or ostomy surgery, at different time-points after surgery.
In total, 82 patients who underwent an ostomy and 141 who did not undergo an ostomy for the treatment of RC at our colorectal surgery department between January 2013 and January 2015 were enrolled. Surgical methods, tumor distance from the anal margin (TD), anastomosis distance from the anal margin (AD) and complications were compered between the non-ostomy and ostomy surgery groups. QOL was compared between the two groups at years 2, 3, and 4 after surgery. The Wexner score and the validated cancer-specific European Organization for Research and Treatment of Cancer (EORTC QLQ-CR30) questionnaire scores were assessed for all patients in January 2017. SPSS 21.0 was utilized for all data analyses.
Surgical methods, TD, and AD significantly differed between the non-ostomy and ostomy surgery groups (all P < .001). However, no differences were found in the number of complications between the groups (P = .483). For the 192 patients undergoing Dixon surgery, role function (RF), global QOL (GQOL), sleep disturbance, and the incidence of constipation showed significant differences between the two groups (P = .012, P = .025, P = .036, and P = .015, respectively). In the 31 cases of permanent ostomy, we observed significant differences in GQOL scores, dyspnea incidence, and financial difficulties across the different years (P = .002, P = .036, and P < .01, respectively). Across all 223 cases, there were significant differences in social function and GQOL scores in the second year after surgery (P = .014 and P < .001, respectively). However, no differences were observed in the other indices across the three time-points.
RC patients undergoing ostomy surgery, especially those with low and super-low RC, revealed poorer defecation function and QOL in the present study. However, 2 years after surgery, most of the defecation and QOL indicators showed recovery.
直肠癌（RC）手术常导致永久性结肠造口，严重限制了患者肠道功能方面的生活质量（QOL）。本研究旨在探讨接受非造口或造口手术的RC患者在术后不同时间点的排便功能和生活质量。
纳入2013年1月至2015年1月在我院结直肠外科接受造口手术的82例患者和未接受造口手术治疗RC的141例患者。比较非造口手术组和造口手术组的手术方式、肿瘤距肛缘距离（TD）、吻合口距肛缘距离（AD）及并发症情况。比较两组术后第2、3和4年的生活质量。2017年1月对所有患者评估Wexner评分和经过验证的癌症特异性欧洲癌症研究与治疗组织（EORTC QLQ-CR30）问卷评分。所有数据分析均采用SPSS 21.0。
非造口手术组和造口手术组在手术方式、TD和AD方面存在显著差异（均P <.001）。然而，两组并发症数量无差异（P =.483）。对于192例行Dixon手术的患者，两组在角色功能（RF）、总体生活质量（GQOL）、睡眠障碍和便秘发生率方面存在显著差异（分别为P =.012、P =.025、P =.036和P =.015）。在31例永久性造口患者中，我们观察到不同年份的GQOL评分、呼吸困难发生率和经济困难存在显著差异（分别为P =.002、P =.036和P <.01）。在所有223例患者中，术后第2年的社会功能和GQOL评分存在显著差异（分别为P =.014和P <.001）。然而，在三个时间点的其他指标上未观察到差异。
在本研究中，接受造口手术的RC患者，尤其是低位和超低位RC患者，排便功能和生活质量较差。然而，术后2年，大多数排便和生活质量指标显示恢复。
