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中华胃肠内镜电子杂志

中华胃肠内镜电子杂志 ›› 2024, Vol. 11 ›› Issue (02) : 81 -87. doi: 10.3877/cma.j.issn.2095-7157.2024.02.003

论著

超级微创手术模式与器官切除模式下结直肠癌患者的生活质量和心理状态变化
蔡朝蓓1, 陈倩倩2,†(), 宁波2, 李惠凯2, 袁新普3, 令狐恩强2,†()   
  1. 1. 100853　北京，解放军总医院第一医学中心消化内科医学部；100853　北京，解放军医学院
    2. 100853　北京，解放军总医院第一医学中心消化内科医学部
    3. 100853　北京，解放军总医院第一医学中心普通外科医学部
  • 收稿日期:2024-03-18 出版日期:2024-05-15
  • 通信作者: 陈倩倩, 令狐恩强
  • 基金资助:
    国家重点研发计划(2022YFC2503600、2022YFC2503601、2022YFC2503604)

Changes in quality of life and psychological status of patients with colorectal cancer under the super minimally invasive surgery mode and the organ resection mode

Zhaobei Cai1, Qianqian Chen1,†(), Bo Ning1, Huikai Li1, Xinpu Yuan2, Enqiang Linghu1,†()   

  1. 1. Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
    2. Chinese PLA Medical Shool, Beijing 100853, China
  • Received:2024-03-18 Published:2024-05-15
  • Corresponding author: Qianqian Chen, Enqiang Linghu
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蔡朝蓓, 陈倩倩, 宁波, 李惠凯, 袁新普, 令狐恩强. 超级微创手术模式与器官切除模式下结直肠癌患者的生活质量和心理状态变化[J]. 中华胃肠内镜电子杂志, 2024, 11(02): 81-87.

Zhaobei Cai, Qianqian Chen, Bo Ning, Huikai Li, Xinpu Yuan, Enqiang Linghu. Changes in quality of life and psychological status of patients with colorectal cancer under the super minimally invasive surgery mode and the organ resection mode[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2024, 11(02): 81-87.

目的

评估超级微创手术(SMIS)模式与器官切除模式下结直肠癌患者的生活质量和心理状态变化。

方法

前瞻性纳入2023年3～8月在解放军总医院第一医学中心住院治疗的结直肠癌患者，根据术中是否切除肠管，将患者分为SMIS组(单纯切除病变而保全肠管)和器官切除组(切除病变及部分肠管)。分别于手术前和术后1、3、6个月收集患者的生活质量和心理状态资料，生活质量的评估选用欧洲癌症研究与治疗组织生活质量问卷C30和CR29；心理状态评估使用疾病进展恐惧简化量表(FoP-Q-SF)、Zung氏焦虑(SAS)和抑郁自评量表(SDS)。

结果

共纳入47例患者，SMIS组24例，器官切除组23例。SMIS组术后1、3、6个月便中带血或黏液、便频和FoP-Q-SF的评分均低于术前水平。器官切除组术后1个月时的体能、胜任能力、社交能力和便中带血或黏液评分低于术前水平；而疲劳、疼痛、呼吸困难、臀部疼痛、味觉异常、胀气、便失禁、皮肤疼痛和排便窘迫评分高于术前水平。器官切除组术后3、6个月时便中带血或黏液评分均低于术前水平；排便窘迫评分均高于术前水平；而FoP-Q-SF、SAS和SDS评分与术前差异无统计学意义。

结论

SMIS模式下，结直肠癌患者术后1、3、6个月的生活质量和心理状态中的疾病进展恐惧均较术前改善；器官切除模式下，术后1个月生活质量下降，随后3至6个月内逐渐上升，而心理状态变化不明显。

关键词: 结直肠肿瘤, 超级微创手术, 器官切除, 生活质量, 心理状态
Objective

To evaluate the changes in quality of life and psychological status in patients with colorectal cancer under the super minimally invasive surgery(SMIS) mode or the organ resection mode.

Methods

Prospectively, patients with colorectal cancer who were hospitalized in the First Medical Center of Chinese PLA General Hospital from March to August 2023 were included.The patients were divided into two groups according to whether intestinal resection was performed during the operation: SMIS group(simple excision of the lesion to preserve the intestinal tract) and organ resection group(excision of part of the intestine along with the lesion).Prior to surgery and postoperatively at 1, 3, and 6 months, data on the patient′s quality of life and psychological state were collected.The quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and-CR29, and the psychological status was evaluated using the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Self-rating anxiety scale (SAS), and Self-rating depression scale (SDS).

Results

A total of 47 patients were included in the study, with 24 in the SMIS group and 23 in the organ resection group.In the SMIS group, the scores for blood or mucus in stool, stool frequency and FoP-Q-SF at the postoperative 1st, 3rd and 6th month were significantly lower than those before operation.Physical fitness, role function, social function, and blood or mucus in stools scores were lower than the preoperative levels in the organ resection group at 1 month postoperatively; while fatigue, pain, dyspnea, buttock pain, taste abnormalities, flatulence, fecal incontinence, skin pain and defecation embarrassment scores were higher than preoperative levels.In the organ resection group, the postoperative 3rd and 6th month scores for blood or mucus in stool were lower than the preoperative level; the score for defecation embarrassment was higher than the preoperative level; however, there were no significant differences in FoP-Q-SF, SAS and SDS compared with the preoperative period.

Conclusion

Under the SMIS mode, the quality of life and fear of disease progression in psychological status for colorectal cancer patients improved at 1, 3, and 6 months postoperatively compared to the preoperative period. Under the organ resection mode, the quality of life significantly declined at 1 month postoperatively, then gradually improved within 3 to 6 months, with no significant changes in psychological status.

Key words: Colorectal neoplasms, Super minimally invasive surgery, Organ resection, Quality of life, Psychological status
表1 2组患者一般资料比较[例(%)]
项目 SMIS组(n＝24) 器官切除组(n＝23) P值
性别     0.654
男 12(50.0) 10(43.5)  
女 12(50.0) 13(56.5)  
年龄(岁，±s) 58±10 54±12 0.185
BMI(kg/m2，±s) 24.2±3.0 24.2±5.2 0.983
aCCI(±s) 2.6±1.6 2.4±1.4 0.736
吸烟史 5(20.8) 8(34.8) 0.285
饮酒史 6(25.0) 6(26.1) 0.932
表2 2组患者疾病和治疗相关资料[例(%)]
项目 SMIS组(n＝24) 器官切除组(n＝23) P值
肿瘤部位     0.680
直肠 12(50.0) 11(47.8)  
左半结肠 7(29.2) 9(39.1)  
右半结肠 5(20.8) 3(13.0)  
肿瘤病理类型     <0.001
重度异型增生 14(58.3) 1(4.3)  
癌(分化程度未评估) 2(8.3) 2(8.7)  
中分化腺癌 7(29.2) 20(87.0)  
低分化鳞癌 1(4.2) 0  
肿瘤病理T分期     <0.001
≤Tis 19(79.2) 3(13.0)  
T1 4(16.7) 7(30.4)  
T2 1(4.2) 2(8.7)  
T3 0 11(47.8)  
肿瘤病理N分期     0.207
N0 24(100) 19(82.6)  
N1a 0 1(4.3)  
N1b 0 2(8.7)  
N2a 0 1(4.3)  
肿瘤脉管侵犯 0 1(4.3) 0.489
肿瘤神经侵犯 0 2(8.7) 0.234
术后化疗 0 7(30.4) 0.012
术后放疗 0 2(8.7) 0.234
图1 2组患者EORTC QLQ-C30子量表线性评分的均值折线图注：SMIS为超级微创手术；EORTC QLQ-C30指欧洲癌症研究与治疗组织生活质量问卷-核心30；*表示组内对应时间点的评分与术前评分相比P<0.05，**为P<0.001；†表示对应时间点SMIS组与器官切除组的评分对比P<0.05，††为P<0.001
图2 2组患者EORTC QLQ-CR29子量表线性评分的均值折线图注：SMIS为超级微创手术；EORTC QLQ-CR29指欧洲癌症研究与治疗组织生活质量问卷-结直肠29；*表示组内对应时间点的评分与术前评分相比P<0.05，**为P<0.001；†表示对应时间点SMIS组与器官切除组的评分对比P<0.05
图3 2组患者心理状态各量表的评分注：SMIS为超级微创手术；FoP-Q-SF指疾病进展恐惧简化量表；SAS指Zung氏焦虑自评量表；SDS指Zung氏抑郁自评量表；*表示组内对应时间点的评分与术前评分相比P<0.05；†表示对应时间点SMIS组与器官切除组的评分对比P<0.05
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