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目的探讨腹腔镜直肠前切除手术对患者生存质量的影响。方法前瞻性非随机对照研究,测定同期接受改良腹腔镜直肠前切除(腔镜组)和开腹直肠前切除手术(开腹组)患者短、中期生存质量评分。结果2007年9月～2008年9月,共63例直肠癌患者入选,其中腔镜组27例,开腹组36例。失访5例,其中腔镜组2例,开腹组3例。两组术前生存质量值比较差异无显著性(P>0.05)。术后2周,患者的生存质量值大幅度下降,开腹组的生存质量评分低于腔镜组(P<0.05)。术后4周,患者的生存质量有所好转,但未达到术前水平(P<0.05),开腹组的生存质量评分仍低于腔镜组(P<0.05)。术后12周,患者的生存质量评分已恢复到术前水平(P>0.05),两组间的比较差异无显著性。术后24个月,两组的生存质量评分均高于术前水平(P<0.05),两组间比较差异也无显著性。结论从生存质量角度,改良的腹腔镜直肠前切除手术较开腹手术有着明显的优势。
Objective To investigate the effect of laparoscopic anterior resection on the quality of life of patients. Methods A prospective, non-randomized controlled study was conducted to determine the short-term and intermediate-term quality of life scores of patients undergoing modified laparoscopic anterior resection (endoscopic group) and open rectocele surgery (open group). Results From September 2007 to September 2008, a total of 63 patients with rectal cancer were enrolled. Among them, 27 were treated with endoscopy and 36 with open surgery. Lost in 5 cases, including 2 cases of endoscopic group, 3 cases of open group. There was no significant difference in preoperative quality of life between the two groups (P> 0.05). After 2 weeks, the quality of life of patients dropped significantly, and the quality of life in open group was lower than that of endoscopic group (P <0.05). After 4 weeks, the quality of life improved, but did not reach the preoperative level (P <0.05). The quality of life in open group was still lower than that in endoscopic group (P <0.05). After 12 weeks, the quality of life of the patients returned to the preoperative level (P> 0.05), with no significant difference between the two groups. At 24 months after operation, the quality of life scores of both groups were significantly higher than those before operation (P <0.05). There was no significant difference between the two groups. Conclusion From the perspective of quality of life, modified laparoscopic anterior resection has obvious advantages over laparotomy.