直肠癌前切除术后生活质量及中医证型研究

发布时间：2018-01-09 11:11

本文关键词：直肠癌前切除术后生活质量及中医证型研究　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:研究直肠癌前切除术后患者排便状况及生活质量;分析前切除综合征的相关因素;探讨直肠癌术后患者的中医辨证分型。方法:随访2010年5月至2016年5月因直肠癌于南京市中医院行直肠前切除术后患者100例,请患者填写LARS评分表、EORTC QLQ-C30(V3.0)生活质量量表,共获得完整资料85例。按照LARS评分表,将患者分为重度ARS、无/轻度ARS两组,比较患者的生活质量,综合分析相关因素,并对43例门诊随访患者进行中医辨证分型。结果:ARS患者共45/85例(52.9%);包括重度ARS患者30/85例(35.3%),轻度ARS患者15/85例(17.6%);LARS评分表中各症状的发生比率为里急后重(69.4%)排便急迫(57.7%)气体失禁(52.9%)便频(42.4%)稀便失禁(38.8%)便秘(11.7%)。比较重度ARS、无/轻度ARS患者的EORTC QLQ-C30得分:在总体健康水平、所有功能维度(躯体功能、角色功能、情绪功能、认知功能、社会功能)、疲倦、腹泻方面的差异具有统计学意义(P均0.05),重度ARS患者生活质量明显更差。年龄、肿瘤下缘距肛缘的距离、放疗是直肠癌前切除术后发生重度ARS的危险因素(P均0.05),但均不是独立危险因素(P均0.05)。43例直肠癌前切除术后患者中,最多见的证型是脾虚湿毒型(n=16,37.2%);随后依次为脾肾两虚型(n=9,20.9%),湿热瘀毒型(n=8,18.6%),肝肾阴虚型(n=6,14.0%),气血两虚型(n=4,9.3%)。结论:直肠癌前切除术后患者的生活质量与ARS的发生密切相关,重度ARS患者生活质量差。高龄、吻合口位置较低以及接受放疗的患者更容易发生重度ARS。直肠癌术后患者以"虚证"或"虚实夹杂"者居多,临床治疗宜以"扶正"为主。
[Abstract]:Objective: to study the defecation status and quality of life (QOL) of patients with rectal cancer after anterior resection. The related factors of preresectomized syndrome were analyzed. Methods: from May 2010 to May 2016, 100 patients with rectal cancer underwent anterior rectal resection in Nanjing Hospital of traditional Chinese Medicine. Patients were asked to fill out LARS score form and EORTC QLQ-C30V3.0) quality of life scale, a total of 85 cases were obtained complete data, according to the LARS score form. The patients were divided into severe ARS group and no / mild ARS group. The quality of life was compared and related factors were comprehensively analyzed. And 43 cases of out-patient follow-up were classified by TCM syndrome differentiation. Results there were 45/85 cases (52.9%) of them. There were 30/85 patients with severe ARS and 15/85 patients with mild ARS. The incidence rate of symptoms in the LARS scale is 69.4%) defecation is urgent (52.7%) gas incontinence is 52.9% (42.4%)) (38.8%)). The constipation was 11. 7%. Severe ARS. EORTC QLQ-C30 scores of patients with no or mild ARS: at the overall health level, all functional dimensions (body function, role function, emotional function, cognitive function, social function, fatigue). The difference in diarrhea was statistically significant (P < 0.05). The quality of life in patients with severe ARS was significantly worse. Age, the distance from the lower margin of tumor to the anal margin. Radiotherapy was the risk factor of severe ARS after anterior resection of rectal cancer (P < 0.05), but it was not an independent risk factor (P = 0.05) in 43 patients with rectal cancer after anterior resection. The most common type of syndrome was spleen deficiency dampness toxin type (NV) 16 ~ (16) and ~ (37. 2) C ~ (-1). Then followed by the spleen and kidney deficiency type, the spleen and kidney deficiency type, the damp-heat stasis toxin type, the damp-heat stasis toxin type, the damp-heat stasis toxin type, the liver and kidney yin deficiency type, the liver and kidney yin deficiency type, the liver and kidney yin deficiency type, the liver and kidney yin deficiency type, the Qi and the blood deficiency type, respectively. Conclusion: the quality of life of patients after anterior resection of rectal cancer is closely related to the occurrence of ARS, and the quality of life of patients with severe ARS is poor. The patients with lower anastomotic site and radiotherapy were more likely to develop severe ARS.After the operation of rectal cancer, the majority of patients were "deficiency syndrome" or "deficiency and solid inclusion", and the main clinical treatment should be "nourishing".
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.37

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