| Summary: | 碩士 === 國立臺灣大學 === 護理學研究所 === 105 === Owing to hereditary factors and Westernized cuisine, the number of patients suffer from colorectal cancer has increased in recent years. Most tumors develop in the lower regions of the intestinal tract (in the junction between the sigmoid colon and the rectum and in the rectum). It is especially difficult for these patients with low rectal cancer to return to the same quality of life they had previously. Besides the psychological impact, the patients undergo the surgery may leave them with dysfunction of defecation, urination and sexual function. These problems cause them inconvenience and impact their quality of live significantly. To reduce this impact, the type of surgery has changed greatly. Abdominoperineal resection (APR) would leave a permanent stoma. This is changed to sphincter-preserving surgery (SPS) that would preserve sphincters. However, the short-term and the long-term impact of the above two surgeries on the patient’s quality of life have not come to a conclusion yet. The purposes of this study are 1) compare the bowel dysfunction and health-related quality of life between patients who have undergone SPS less than six months and more than six months; 2) examine the influence of the degree of bowel dysfunction after SPS and family function on the overall quality of life; and 3) compare the overall quality of life between patients who have undergone SPS and APR.
This study adopts purposive sampling and uses cross-sectional, descriptive and correlational study design examining cases from outpatients at a Medical Center in Northern Taiwan with data collection by using structured questionnaires. Participants are patients with lower rectal cancer. 78 of them had undergone sphincter-preserving surgery, and 10 of them had undergone abdominoperineal resection. The measurement tools include the basic case demographic information, EORTC QLQ-C30 and EORTC QLQ-CR29, the low anterior resection syndrome score (LARS score), and the family APGAR index. The results were analyzed by t-tests, one-way analysis of variance (ANOVA), multiple regression, and other methods.
The results show that the overall quality of life of patients who have undergone sphincter-preserving surgery can be predicated by family function and the degree of bowel dysfunction after surgery. The patient’s quality of life increased along with the better family function, and decreased along with the higher degree of bowel dysfunction. Moreover, this study also found a significant difference between the quality of life in patients who have undergone SPS and APR over six months. The patients who have undergone SPS have the lower quality of life. We further divided patients who underwent SPS into two groups according to their type of surgery: total mesorectal excision (TME) and low anterior resection (LAR) and analyze the difference between TME, LAR, and abdominoperineal resection (APR). The results show that the overall quality of life of patients who have undergone TME have the lower quality of life than that of LAR and APR. There is no significant difference between LAR and APR.
The results of this study provide insight into the quality of life of patients who have undergone sphincter-preserving surgery or not for lower rectal cancer, as well as drawing a relationship between the quality of life, the degree of bowel dysfunction and family function. It would help healthcare professionals to plan the unique interventions according to the different degree of bowel dysfunction and family function, and strengthen family function to help patients and their family to adapt to their new way of life and raise their quality of life.
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