低位前方切除術・前方切除術を受けた大腸癌患者のQuality of Life(QOL)―排便機能障害とQUIK-Rの関連

Quality of Life of Outpatients Treated with Low Anterior Resection or Anterior Resection for Colorectal Cancer：Correlation Between Dyschezia and Self-completed QOL Questionnaire

要旨

　本研究の目的は，低位前方切除術（LAR）や前方切除術（AR）を受けた患者の退院後の排便機能障害とQOLの実態を把握し，それらの関係を検討することであった．

　質問紙は，排便障害評価尺度（DDAS）と自己記入式QOL質問表（QUIK-R），およびデモグラフィックシートから構成し，LARまたはARを受けた後3年以内にある患者192名が研究対象となった．対象者の平均年齢は64.6歳（SD＝10.4）であった．データの分析には，Mann-Whitney検定，Kruskal-Wallis検定，Spearman's 順位相関，重回帰分析（step-wise法）を使用した．

　ARを受けた対象者に比較して，LARを受けた対象者でDDASの得点が有意に高く，DDASとQUIK-Rには正の相関が見られた．特に強い相関があったのは，「Soiling」であった．また，重回帰分析ではQUIK-Rの得点変動の22.3％がDDASと術式によって説明された．

　これらのことより，外来通院をする大腸癌術後患者においては，術式が排便機能障害の程度に影響し，「Soiling」等の排便機能障害がQOLに影響していることが示唆された．

Abstract

　This study examines the correlation between dyschezia and quality of life in an outpatient population that received either low anterior resection (LAR) or an anterior resection (AR) as treatment for colorectal cancer.

　The outpatients answered a questionnaire examining the severity of their dyschezia and it's impact on their quality of life. One hundred ninety two outpatients, with a mean age of 64.6 years (SD=10.4 years) and from 1 to 36 months after surgical resection responded to the questionnaire. Two assessment scales were included in the questionnaire: The Defective Dysfunction Assessment Scale (DDAS) and a self-completed questionnaire for QOL revised (QUIK-R). Data were analyzed using a Mann-Whitney test, Kruskal-Wallis test and Spearman rank correlation coefficient, and step-wise multiple regression was also performed.

　DDAS scores were significantly higher for patients receiving low anterior resection (LAR) than for those receiving anterior resection (AR). A significant relationship was also observed between DDAS and QUIK-R scores, in particular, between“soiling”on the DDAS. Multiple regression analysis revealed that DDAS and resection technique used for treatment accounted for 22.3% of the variance in QUIK-R.

　In conclusion, the findings suggest that the severity of dyschezia is related to the resection technique used to treat colorectal cancer. Furthermore the severity of dyschezia was found to exert a significant influence on quality of life.