• 四川大學(xué)華西醫(yī)院普外三科（成都610041）;

目的　 對低位直腸癌患者行腹腔鏡全直腸系膜切除保肛術(shù)（LTME+ASP）后的生活質(zhì)量進(jìn)行評估。
方法 　以2001年6月至2004年3月期間在四川大學(xué)華西醫(yī)院直腸癌治療組行LTME+ASP的125例低位直腸癌患者為研究對象（LTME組），同期103例行開腹全直腸系膜切除保肛術(shù)（OTME+ASP）的患者作為對照（OTME組），采用國際標(biāo)準(zhǔn)問卷QLQ-C30和QLQ-CR38，分別于術(shù)后3～6個月、12～18個月、 gt;24個月3個時段進(jìn)行前瞻性調(diào)查。
結(jié)果 　LTME 組的軀體功能、性功能及性快感分別在第1、2、3時段顯著優(yōu)于OTME組。兩組女性性障礙差異無統(tǒng)計(jì)學(xué)意義，而LTME組在第1、2時段的排尿障礙和第2時段的男性性障礙均顯著輕于OTME組。從第1時段到第2時段，兩組的角色功能、認(rèn)知功能、社會功能、未來期望、整體印象、疲乏、惡心嘔吐、疼痛、失眠、厭食、腹瀉、化療副反應(yīng)、排便障礙、消瘦以及LTME組的性功能、排尿障礙和男性性障礙均顯著改善； 而兩組的性快感以及OTME組的性功能則在第3時段顯著改善。
結(jié)論 　LTME+ASP治療低位直腸癌可獲得優(yōu)于開腹手術(shù)的術(shù)后生活質(zhì)量，其優(yōu)勢主要體現(xiàn)在軀體功能、排尿障礙、性功能、性快感、男性性障礙等方面，而以上優(yōu)勢主要存在于術(shù)后中、短期； LTME組和OTME組術(shù)后患者的生活質(zhì)量均隨時間延長趨于好轉(zhuǎn)，術(shù)后1年最為顯著, LTME組術(shù)后的排尿障礙和性功能比OTME組術(shù)后恢復(fù)快。

引用本文： 于永揚(yáng),楊烈,周總光,李園,徐兵,劉海義,宋軍民,蔣小. 腹腔鏡全直腸系膜切除保肛術(shù)后生活質(zhì)量評估. 中國普外基礎(chǔ)與臨床雜志, 2007, 14(5): 524-529. doi: 復(fù)制

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1. 　Enker WE. Total mesorectal excision——the new golden standard of surgery for rectal cancer [Ｊ]. Ann Med, 1997; 29(2)∶127.
2. 　Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery——the clue to pelvic recurrence? [Ｊ]. Br J Surg， 1982; 69(10)∶613.
3. 　韓方海， 張肇達(dá)， 伍曉汀， 等. 低位直腸癌保肛手術(shù) [Ｊ]. 中國普通外科雜志， 2002； 11（11）∶678.
4. 　Salerno G, Daniels IR, Heald RJ. From bench to bed side: The concept of total mesorectal excision for rectal cancer [Ｊ]. Eur Surg, 2005; 37(4)∶238.
5. 　Nesbakken A, Nygaard K, Westerheim O, et al. Local recurrence after mesorectal excision for rectal cancer [Ｊ]. Eur J Surg Oncol, 2002; 28(2)∶126.
6. 　Heald RJ, Karanjia ND. Results of radical surgery for rectal cancer [Ｊ]. World J Surg, 1992; 16(5)∶848.
7. 　周總光. 微創(chuàng)化全直腸系膜切除保肛治療低位直腸癌： 機(jī)遇與挑戰(zhàn) [Ｊ]. 中國普外基礎(chǔ)與臨床雜志， 2003； 10(2)∶100.
8. 　李立. 結(jié)直腸癌外科應(yīng)用技術(shù)的規(guī)范與創(chuàng)新（四） [Ｊ]. 中國普外基礎(chǔ)與臨床雜志， 2006； 13(4)∶461.
9. 　卿三華， 巴明臣. 我國腹腔鏡直腸癌根治術(shù)的現(xiàn)狀和展望 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志， 2005； 12(6)∶540.
10. 　Tsang WW, Chung CC, Kwok SY, et al. Laparoscopic sphincter-preserving total mesorectal excision with colonic J-pouch reconstruction: five-year results [Ｊ]. Ann Surg, 2006; 243(3)∶353.
11. 　Leroy J, Jamali F, Forbes L, et al. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes [Ｊ]. Surg Endosc, 2004; 18(2)∶281.
12. 　Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology [Ｊ]. J Natl Cancer Inst, 1993; 85(5)∶365.
13. 　Sprangers MA, te Velde A, Aaronson NK. The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). European Organization for Research and Treatment of Cancer Study Group on Quality of Life [Ｊ]. Eur J Cancer, 1999; 35(2)∶238.
14. 　Zhou ZG, Hu M, Li Y, et al. Laparoscopic vs open total mesorectal excision with anal sphincter preservation for low rectal cancer [Ｊ]. Surg Endosc， 2004; 18（8）∶1211.
15. 　Jayne DG, Brown JM, Thorpe H, et al. Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique [Ｊ]. Br J Surg, 2005; 92(9)∶1124.
16. 　楊烈， 周總光. 直腸癌術(shù)后生存質(zhì)量的評估 [Ｊ]. 消化外科， 2003; 2（6）∶449.
17. 　Hojo K, Vernava AM 3rd, Sugihara K, et al. Preservation of urine voiding and sexual function after rectal cancer surgery [Ｊ]. Dis Colon Rectum, 1991; 34(7)∶532.
18. 　Camilleri-Brennan J, Steele RJ. Quality of life after treatment for rectal cancer [Ｊ]. Br J Surg, 1998; 85(8)∶1036.
19. 　Williamson ME, Lewis WG, Finan PJ, et al. Recovery of ph-ysiologic and clinical function after low anterior resection of the rectum for carcinoma: myth or reality? [J]. Dis Colon Rectum, 1995; 38（4）∶411.
20. 　Ikeuchi H, Kusunoki M, Shoji Y, et al. Clinico-physiological results after sphincter-saving resection for rectal carcinoma [Ｊ]. Int J Colorectal Dis, 1996; 11(4)∶172.
21. 　Whynes DK, Neilson AR. Symptoms before and after surgery for colorectal cancer [Ｊ]. Qual Life Res, 1997; 6(1)∶61.
22. 　McAnena OJ, Heald RJ, Lockhart-Mummery HE. Operative and functional results of total mesorectal excision with ultra-low anterior resection in the management of carcinoma of the lower one-third of the rectum [Ｊ]. Surg Gynecol Obstet, 1990; 170(6)∶517.
  1. 1. 　Enker WE. Total mesorectal excision——the new golden standard of surgery for rectal cancer [Ｊ]. Ann Med, 1997; 29(2)∶127.
  2. 2. 　Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery——the clue to pelvic recurrence? [Ｊ]. Br J Surg， 1982; 69(10)∶613.
  3. 3. 　韓方海， 張肇達(dá)， 伍曉汀， 等. 低位直腸癌保肛手術(shù) [Ｊ]. 中國普通外科雜志， 2002； 11（11）∶678.
  4. 4. 　Salerno G, Daniels IR, Heald RJ. From bench to bed side: The concept of total mesorectal excision for rectal cancer [Ｊ]. Eur Surg, 2005; 37(4)∶238.
  5. 5. 　Nesbakken A, Nygaard K, Westerheim O, et al. Local recurrence after mesorectal excision for rectal cancer [Ｊ]. Eur J Surg Oncol, 2002; 28(2)∶126.
  6. 6. 　Heald RJ, Karanjia ND. Results of radical surgery for rectal cancer [Ｊ]. World J Surg, 1992; 16(5)∶848.
  7. 7. 　周總光. 微創(chuàng)化全直腸系膜切除保肛治療低位直腸癌： 機(jī)遇與挑戰(zhàn) [Ｊ]. 中國普外基礎(chǔ)與臨床雜志， 2003； 10(2)∶100.
  8. 8. 　李立. 結(jié)直腸癌外科應(yīng)用技術(shù)的規(guī)范與創(chuàng)新（四） [Ｊ]. 中國普外基礎(chǔ)與臨床雜志， 2006； 13(4)∶461.
  9. 9. 　卿三華， 巴明臣. 我國腹腔鏡直腸癌根治術(shù)的現(xiàn)狀和展望 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志， 2005； 12(6)∶540.
  10. 10. 　Tsang WW, Chung CC, Kwok SY, et al. Laparoscopic sphincter-preserving total mesorectal excision with colonic J-pouch reconstruction: five-year results [Ｊ]. Ann Surg, 2006; 243(3)∶353.
  11. 11. 　Leroy J, Jamali F, Forbes L, et al. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes [Ｊ]. Surg Endosc, 2004; 18(2)∶281.
  12. 12. 　Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology [Ｊ]. J Natl Cancer Inst, 1993; 85(5)∶365.
  13. 13. 　Sprangers MA, te Velde A, Aaronson NK. The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). European Organization for Research and Treatment of Cancer Study Group on Quality of Life [Ｊ]. Eur J Cancer, 1999; 35(2)∶238.
  14. 14. 　Zhou ZG, Hu M, Li Y, et al. Laparoscopic vs open total mesorectal excision with anal sphincter preservation for low rectal cancer [Ｊ]. Surg Endosc， 2004; 18（8）∶1211.
  15. 15. 　Jayne DG, Brown JM, Thorpe H, et al. Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique [Ｊ]. Br J Surg, 2005; 92(9)∶1124.
  16. 16. 　楊烈， 周總光. 直腸癌術(shù)后生存質(zhì)量的評估 [Ｊ]. 消化外科， 2003; 2（6）∶449.
  17. 17. 　Hojo K, Vernava AM 3rd, Sugihara K, et al. Preservation of urine voiding and sexual function after rectal cancer surgery [Ｊ]. Dis Colon Rectum, 1991; 34(7)∶532.
  18. 18. 　Camilleri-Brennan J, Steele RJ. Quality of life after treatment for rectal cancer [Ｊ]. Br J Surg, 1998; 85(8)∶1036.
  19. 19. 　Williamson ME, Lewis WG, Finan PJ, et al. Recovery of ph-ysiologic and clinical function after low anterior resection of the rectum for carcinoma: myth or reality? [J]. Dis Colon Rectum, 1995; 38（4）∶411.
  20. 20. 　Ikeuchi H, Kusunoki M, Shoji Y, et al. Clinico-physiological results after sphincter-saving resection for rectal carcinoma [Ｊ]. Int J Colorectal Dis, 1996; 11(4)∶172.
  21. 21. 　Whynes DK, Neilson AR. Symptoms before and after surgery for colorectal cancer [Ｊ]. Qual Life Res, 1997; 6(1)∶61.
  22. 22. 　McAnena OJ, Heald RJ, Lockhart-Mummery HE. Operative and functional results of total mesorectal excision with ultra-low anterior resection in the management of carcinoma of the lower one-third of the rectum [Ｊ]. Surg Gynecol Obstet, 1990; 170(6)∶517.