Quality Of Life In Postoperative Patients Research Articles

A network meta-analysis of surgery for chronic pancreatitis: impact on pain and quality of life

Background: The surgical operation associated with improved pain and quality of life (QoL) in patients with chronic pancreatitis (CP) is unknown. Method: The Scopus, EMBASE, Medline and Cochrane databases were systematically searched until May 2019 and all randomised trials (RCTs) comparing surgical operations for CP pain were included in a network meta-analysis (NMA). Results: Four surgical operations for treating CP were directly compared in eight RCTs including 597 patients. Patients were mainly male (79%, 474/597) with alcoholic CP (85%, 382/452). Surgical operations included were pancreatoduodenectomy (224, 38%), Berne procedure (168, 28%), Beger procedure (133, 22%), and Frey procedure (72, 12%). NMA revealed that the Beger procedure ranked best for pain relief, while the Frey procedure ranked best for postoperative QoL, postoperative pancreatic fistula rate and postoperative exocrine insufficiency rate. Overall the Frey procedure ranked best for the combination of primary outcome measures based on surface under cumulative ranking curve scores. Conclusions: Overall the Frey procedure is the best operation for both pain relief and postoperative QoL in patients with CP. New validated tools to assess CP pain and the influence of various types of pain patterns on QoL will allow future trials to better stratify patients. Given the different inclusion criteria, pain and QoL assessment and duration of symptoms, and increasing uptake of enhanced recovery protocols, further trials are required to investigate the role of surgery for different CP phenotypes, timing of surgery and in defining the role of surgery in relation to endotherapy.

Оценка качества жизни детей, оперированных по поводу «суперкороткой формы» болезни Гиршпрунга

So far, there have been very few reports on the quality of life (QoL) in children receiving treatment for Hirschsprung's disease in both Russian and foreign literature. Objective. To evaluate the QoL of children with ultrashort Hirschsprung's disease. Patients and methods. We evaluated the QoL in 203 patients with ultrashort Hirschsprung's disease. Group 1a included 119 children who underwent Linn surgery, whereas group 1b comprised 84 children who underwent posterior myectomy. Results. The preoperative QoL of children with ultrashort Hirschsprung's disease was lower than that in healthy children. In the early postoperative period, the QoL in patients was still lower than that in controls; however, it slightly increased compared to preoperative QoL. Twelve months postoperatively, patients' QoL was insignificantly lower than the QoL of healthy children, but has improved significantly compared to preoperative QoL. Conclusion. Comparison of postoperative QoL in patients with ultrashort Hirschsprung's disease showed that children in both groups demonstrated positive dynamics after surgery compared to preoperative parameters. Patients from group 1a had a more pronounced improvement in their QoL than patients from group 1b. Key words: Hirschsprung's disease, quality of life, ultrashort Hirschsprung's disease

Quality of life and related risk factors after breast reconstruction in breast cancer patients.

Breast cancer is the most frequently occurring cancer in women globally, using radical mastectomy as the main clinical treatment. This study aims to investigate the quality of life and related factors in patients after breast reconstruction. Female patients undergoing breast reconstruction after radical mastectomy between February 20, 2014 and February 20, 2019 in the Department of Tumor or the Department of Thyroid and Breast Surgery in the Affiliated Hospital of North Sichuan Medical College and Nanchong Central Hospital were surveyed. The patients' basic information was collected using a questionnaire prepared by the research team, and the Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaire was used to assess the patients' quality of life. Multivariate linear regression analysis was performed to explore the factors impacting the change of FACT-B scores one year after surgery. A total of 150 patients were included. 143 of them had complete data, and 7 patients were lost to follow-up. Compared with the preoperative results, the scores of all dimensions of the FACT-B scale and the overall health status of the patients were significantly reduced at 3 months after surgery, which recovered to the preoperative level at 6 months after surgery (P<0.05), and significantly increased at 12 months after surgery (P<0.05). The results showed that age ≥40 years, menopause, postoperative complications, and endocrine therapy were risk factors for decreased quality of life at 12 months after breast reconstruction. Meanwhile, tumor stage 0 or stage I and immediate breast reconstruction were protective factors for quality of life at 12 months after breast reconstruction (P<0.05). The postoperative quality of life of patients with breast reconstruction is relatively high. Older age, post-menopause, postoperative complications, endocrine therapy, advanced tumor stage, and delayed reconstruction are all risk factors for decreased quality of life of patients. Targeted measures should be taken to improve the postoperative life quality of patients, such as paying more attention to the older or post-menopausal patients, as well as those with postoperative complications, endocrine therapy, high tumor stage, or delayed breast reconstruction.

Retrospective analysis of curative effect of total pelvic organ resection and anal preservation in 20 patients with recurrence of cervical cancer after radical radiotherapy

Objective: To explore the surgical method and effect of en bloc pelvic resection and anal preservation after radical radiotherapy for cervical cancer. Methods: Clinical data of 20 cervical cancer patients with central recurrence after radical radiotherapy underwent en bloc pelvic resection in the Tumor Hospital of Zhengzhou University and Hainan Provincial People's Hospital from January 2013 to December 2017 were retrospectively analyzed. The operative time, intraoperative blood loss, length of stay, postoperative anal function and postoperative complications were evaluated. Results: The median operation time of 20 patients with anal preservation after en bloc pelvic resection was 135.2 min, the median intraoperative blood loss was 680 ml, and the median hospitalization time was 16.5 days. Among them, 18 patients had good postoperative healing, and the anal function gradually returned to normal within 6 months after surgery, defecated 1~2 times per day.One patient showed incomplete adhesion between the external colon and the anus. One patient presented with pre-sacral infection. Postoperative pathology confirmed the recurrences in 20 patients, of which 11 cases were squamous cell carcinoma, 7 cases were adenocarcinoma, 2 cases were adenosquamous cell carcinoma. Conclusions: It is safe and reliable to preserve anus after en bloc pelvic resection for cervical cancer patients with radical radiotherapy. The anus function is good enough to improve the postoperative life quality of patients significantly.

Quality of life is not affected by thyroid surgery in nontoxic benign goitre in long-term surveillance-A prospective observational study.

ObjectiveQuality of life (QoL) has so far seldom been taken into account by default in decision‐making for surgical indication in thyroid surgery. Therefore, we compared pre‐ and postoperative QoL of patients using the EuroQoL‐5D (EQ‐5D) questionnaire. The influence of certain socio‐economic factors on QoL as a second end‐point was considered.DesignProspective cohort study.PatientsAbout 153 patients with euthyroid symptomatic benign goitre after hemi‐ and total thyroidectomy (follow‐up 83.6%) have been included.MeasurementsThe EQ‐5D questionnaire was used prior to and 1 year after surgery. In addition, a questionnaire for assessment of socio‐economic status was collected.ResultsFor n = 90 (n = 67 female, n = 23 male), total thyroidectomy (TT) and, for n = 63 (n = 45 female, n = 18 male), hemithyroidectomy (HT) were performed. None permanent dysfunction of the vocal cord was recorded. Transient symptomatic hypocalcaemia was detected in 9% of the thyroidectomy group (8/90 patients). At follow‐up, 86% of patients showed either no change or improved QoL. About 14% of patients complained of deteriorated QoL, regardless of the extent of surgery. Socio‐economic factors did not influence postoperative QoL.ConclusionsResults indicate that in pre‐operative consultation of patients with benign goitre, the improvement of QoL should be taken into account for decision‐making in cases of ambiguous surgical indication. Contrary to current discussions that too much thyroid surgery is performed in Germany, we can recommend presenting surgery as an equivalent option to watchful waiting as QoL is at least preserved or improved. The extension of the resection should, however, be decided individually.

Morphometric analyses of clavicle's nutrient foramen.

Fractures of the clavicle, which has an important location and function in the upper extremity and shoulder joint, compose 10% of all fracture cases. During the osteosynthesis of clavicle fractures and in the post-operative period of patients, considering the detailed morphometric and topographic properties of the nutrient foramen of clavicle is important to avoid the disruption of arterial nutrition of the clavicle and prevent unexpected injuries. The aim of this study was to investigate the morphometric properties of the nutrient foramen of clavicle in more detail using computedtomography images. Computed tomography images of 116 healthy individuals (56 women/60 men) who had no pathology history were included in the presented study. Computed tomography images were reconstructed three-dimensionally using free-licensed Horos v3.3.3 software. Then, distances from clavicle's nutrient foramen to sternal end, anterior and posterior edges of the clavicle were measured. Statistical analyses were completed using SPSS v21 software. Our results demonstrated that the nutrient foramen of clavicle was located closer to the sternal end of the clavicle. The shortest distance to the sternal edge of clavicle was measured as 3.3cm. Analyses of gender differences indicated that statistically significant differences were in favor of men. However, topographic properties of the clavicle's nutrient foramen were not affected by age. Nutrient foramen is mostly located closer to the sternal end of clavicle. Especially during osteosynthesis of clavicle fractures at the sternal end, maintaining the arterial supply of clavicle is of great importance for increasing the post-operative life quality of patients.

Investigation of quality of life in patients undergoing oral vestibular thyroid surgery

Objective To explore the basic conditions and postoperative quality of life in patients undergoing oral vestibular thyroid surgery. Methods A total of 128 patients undergoing oral vestibular thyroid surgery were enrolled in the Department of Head and Neck Surgery from March 2015 to April 2018. On the basis of routine thyroid tumor care, we used telephone, WeChat public platform, WeChat group, QQ, and Email. Questionnaires such as information technology and clinic review. Correlation analysis was performed using SPSS 22.0. Results According to the analysis of SPSS statistical software, the postoperative recovery of the patients is good, and more than 95% of the patients have the feeling of no or a little for symptoms, and 91.8% (102/111) and 93.6% (104/111) of the patients have the perception of the general health status and life quality of the patients in the past 1 week respectively. Analysis of variance of postoperative life quality of patients, postoperative regression post was significantly correlated with postoperative social cognition, insomnia and economic difficulties of patients. The education level, occupation, marital status and family income of the patients all had significant influences on the postoperative economic status of the patients, and the differences were statistically significant (t=2.66-4.74, P<0.05). In the regression analysis of patients′ life quality, emotional function and physical function were independent risk factors affecting patients′ life quality, with statistical significance (t=-2.072, -5.564, P < 0.05). Conclusion Endoscopic thyroidectomy via oral vestibule has the advantages of good effect, beautiful appearance and high quality of life, which is worth popularizing and applying. Key words: Information technology; Multi-dimensional network intervention; Thyroid surgery nursing; Transoral vestibular endoscopy; Quality of life

Combination of Ginsenoside H dripping pills and cyclophosphamide improve paraneoplastic syndrome and inhibit postoperative recurrence via the reversion of Th1/Th2 shift.

Non-small-cell lung cancer (NSCLC) is recognized as the most common malignant disease worldwide and combination treatment is recommended as its first line therapy. As a Ph2 clinical product, Ginsenoside H dripping pills (GH) is proposed as an adjuvant of chemotherapy. In the present study, we utilized a postoperative model to evaluate the efficacy of GH on the functions of anti-recurrence and improvement of life quality when combined with chemotherapeutic drug cyclophosphamide (CTX). Specifically, the anti-recurrence effect was evaluated by tumor inhibiting rate and the improvement of life quality was evaluated by the remission of splenomegaly and emaciation. The underlying mechanisms were explored via quantitative real time-PCR, Elisa and IHC staining. Results showed that GH had a synergy when combined with CTX against tumor recurrence, significantly improved the life quality of postoperative patients via remitting splenomegaly and emaciation. H&E staining showed that GH could increase the number of splenic T cells, which were inhibited after CTX administration. Furthermore, the reversion of Th1/Th2 shift, which had been verified by different methods, may account for one of the mechanisms of the synergy. All these results indicated Ginsenoside H dripping pills as a promising adjuvant for postoperative chemotherapy of NSCLC.

Prospective comparison of post-operative quality of life (QOL) after laparoscopic total extra-peritoneal (TEP) and trans-abdominal pre-peritoneal (TAPP) repair of indirect inguinal hernia

Background: As the laparoscopic method is becoming a popular choice of repair, the need to evaluate its impact on the patient’s quality of life (QOL) is also warranted. This study was undertaken to compare post operative QOL in patients undergoing Totally Extraperitoneal (TEP) and Transabdominal preperitoneal (TAPP) repair for indirect inguinal hernia.Methods: This prospective observational study was conducted in the Department of General Surgery at VMMC and Safdarjung Hospital, from June 2016 to March 2018. Patients with uncomplicated indirect inguinal hernia were included in the study after obtaining their informed consent. Post-operative QOL was evaluated using EuraHS-QOL scale at 24 hours and 1, 3 and 6 months after the surgery.Results: A total of sixty patients were enrolled-30 in TEP group and 30 in TAPP group. There was no statistical significant difference in scores at 24 hours follow-up except cosmetic discomfort domain, with higher scores in TAPP (p-value=0.014). Statistical significant difference was present at 1 month follow up with higher scores in TAPP (p-value=0.011). At 3 and 6 months, no statistical difference was found in the scores.Conclusions: Present study demonstrates a significant advantage of TEP over TAPP up to 1-month follow-up, in terms of post-operative QOL. Choosing a superior laparoscopic method between TEP and TAPP requires high powered RCTs with long term follow up to assess the technical advantages and post-operative complications along with post-operative quality of life in patients.

Curative effect of artificial femoral head replacement and its effect on hip joint function and complications of senile patients with femoral intertrochanteric fracture.

Curative effect of artificial femoral head replacement on hip joint function and complications of elderly patients with femoral intertrochanteric fracture were investigated. Eighty patients who were operated for femoral intertrochanteric fractures operation were randomly divided into observation group (n=40) and control group (n=40). The observation group was treated with artificial femoral head replacement, while the control group received internal proximal femur locking plate fixation. In the observation group, the operation time was shorter than that in the control group (P<0.05). The intraoperative bleeding was less than that in the control group (P<0.05). The postoperative indwelling drainage time was shorter than that in the control group (P<0.05). Besides, at 3, 6 and 12 months after operation, 10 m walking speed in the observation group was significantly higher than that in the control group (P<0.05). The 5-time sit-stand time was shorter than that in the control group (P<0.05). At 1 week, 1 month, 3, 6 and 12 months after operation, Harris hip joint scores and visual analogue scale scores in the observation group were both superior to those in the control group (P<0.05). Moreover, the total hospitalization time in the observation group was shorter than that in the control group. Time of walking on crutches and walking without crutches was earlier than that in the control group (P<0.05). The overall proportion of postoperative chronic pain, thrombosis and failed surgery in the observation group was significantly lower than that in the control group (P<0.05). Finally, physical and psychological scores in the observation group after intervention were obviously higher than those in the observation group before intervention and the control group after intervention (P<0.05). Artificial femoral head replacement is characterized by the short operation time, less intraoperative bleeding, fast postoperative recovery of joint function, low degree of pain and fewer complications in the treatment of senile femoral intertrochanteric fracture, which can improve the postoperative life quality of patients.

Effect of induction chemotherapy on the quality-of-life in patients with advanced stage tongue cancer by a prospective study.

sObjectiveTo assess how induction chemotherapy affects the quality-of-life (QoL) in patients with advanced tongue cancer.MethodsThis prospective study included patients who were diagnosed with advanced tongue cancer. Each patient was asked to complete the University of Washington QoL (UW-QoL), version 4, questionnaire preoperatively and at 12 months after surgery. Patients were divided into two groups based on whether or not they received induction chemotherapy.ResultsOf the 192 patients included in the analysis, 145 patients had received induction chemotherapy. There were no significant differences regarding age, sex, tumour stage, node stage, flap reconstruction, tumour resection range and radiotherapy between the two groups. The mean total hospital cost was significantly higher in patients who underwent induction chemotherapy compared with those who did not (68 000 versus 44 000 Yuan Renminbi, respectively). The two groups had similar pre-treatment and post-treatment composite QoL scores and in the 12 individual domains.ConclusionInduction chemotherapy had a limited effect on postoperative QoL in patients with advanced tongue cancers, but it cost significantly more to administer.

The role of waterjet dissection in improving erectile function and continence after nerve-sparing prostatectomy

Erectile dysfunction (ED) and urinary incontinence (UI) following radical prostatectomy (RP) adversely impact patients psycho-emotional status reducing the quality of life and treatment satisfaction. To investigate the rates of regaining continence and erectile function (EF) after nerve-sparing radical retropubic prostatectomy (NS-RRP) and nerve-sparing laparoscopic radical prostatectomy (NS-LRP) in the early postoperative period. The study comprised 116 patients who preserved sexual activity and the ability to have sex. 64 patients underwent standard resection of NVB (34 RRP and 30 LRP) and in 52 patients the NVB resection was performed using a waterjet dissector (WD) (30 RRP and 22 LRP). All operations were performed by one surgeon with the experience of over 350 RRP and 150 LRP. The study patients had low and moderate risk prostate cancer, according to DAmico risk classification. Our study findings showed that patients who underwent the WD of NVB had significantly greater IIEF-5 scores (by 2.8 scores) at 8 weeks than after the standard NS-RP. After 6 month follow-up the scores increased by 3.5 points. Patients who underwent NS-RP + WD achieved a successful sexual intercourse 3 months after surgery (regardless of the use of PDE5 inhibitors). In the group of patients who underwent standard NS-RP, it took a longer time to achieve a successful sexual intercourse. Sixty-seven percent of patients who underwent NS-RP + WD were fully continent at one month follow-up after removal of urethral catheter, while most patients treated with standard NS-RP (41%) had mild stress UI. After 3 months follow-up, among patients who underwent NS-RP + WD only one patient had mild stress UI and the vast majority (95%) of patients were fully continent. At 6 months after removal of the urethral catheter there were no significant differences between the groups in regaining urinary continence. Waterjet dissection of NVB significantly improves patients postoperative quality of life due to early recovery of urinary continence and EF.

A prospective multicenter observational study of surgical palliation examining postoperative quality of life in patients treated for malignant gastric outlet obstruction caused by incurable advanced gastric cancer.

6 Background: Decision-making for surgical palliation remains one of the most challenging clinical scenarios since quality of life (QOL) is a key component of cancer care. We conducted this study to examine the impacts of surgical palliation on postoperative QOL in patients (pts) with malignant gastric outlet obstruction (GOO) caused by incurable primary gastric cancer (GC). Methods: Eligibility included (1) no oral intake or liquids only requiring parenteral nutrition (2) aged ≥20 (3) surgically fit (4) ECOG PS of 0-2 and (5) written IC. Patients underwent either palliative distal/total gastrectomy (DG/TG) or gastrojejunostomy (GJS). Treatment choice was left to the discretion of the physician. Validated QOL instruments (EORTC QLQ-STO22 and EuroQol-5D) assessed QOL at baseline, 2 weeks (wks), 1 month (m), and 3 months following the surgical palliation, and two observational outcomes (postoperative improvement of oral intake, and safety of surgical intervention) were evaluated. Results: 104 pts, 71 males and 33 females with a median age of 68 years, were enrolled. The types of surgery were DG in 23 pts, TG in 9 pts, GJS in 70 in pts, and exploratory laparotomy in 2 pts. Baseline QOL questionnaires were completed by 103 (99.0%) pts. Among the 104 pts, 98 (94.2%), 100 (96.1%), and 81 (77.9%) completed the 2-wk, 1-m, and 3-m follow-up survey, respectively. The mean baseline EQ-5D score was 0.74 (SD, 0.21). During the follow-up period, the mean scores remained consistent with the baseline scores; the change from baseline score was within ± 0.05 for the index. Many pts came to eat solid food at 2 wks postsurgery and remained tolerable thereafter (from 0 at baseline to 82, 85, 75 pts at 2 wks, 1 m, and 3 ms, respectively). Overall morbidity rate of ≥grade 3 on Clavien-Dindo classification and 30-day postoperative mortality rate was 9.6% (10 pts) and 2.0% (2 pts) with a median hospital stay of 13 days and re-operation rate of 3.9% (4 pts). Conclusions: In pts with malignant GOO caused by advanced GC, surgical palliation maintained patient QOL while improving solid food intake with an acceptable surgical safety. Clinical trial information: UMIN000023494.

Clinical observation of the tubular stomach substitute for esophagus anastomosis in the radical surgery of esophageal cancer

Objective To investigate the clinical treatment effect of tubular stomach substitute for esophagus anastomosis in the radical surgery of esophageal cancer. Methods Ninety-seven patients diagnosed with esophageal cancer in the First Affiliated Hospital of Soochow University from June 2013 to June 2015 were selected. They were divided into two groups, 51 patients using the gastric tube substitute for esophagus anastomosis in the gastric tube group, and 46 patients using the traditional full stomach substitute for esophagus anastomosis in the whole stomach group. The operation times, intraoperative blood losses, the amount of postoperative gastrointestinal decompression, hospital stays, pathologic stages and incidences of complications after surgery in the two groups were observed and compared. Results There were no preoperative death in the two groups. The gastric tube group took more operating time than the whole stomach group [(287.43±23.64)min vs. (266.13±26.47)min], with a significant difference (t=2.279, P=0.031). In the comparison of the amount of gastrointestinal decompression, the gastric tube group was less than the whole stomach group [(1 908.14±327.97)ml vs. (2 221.93±323.87)ml], with a significant difference (t=-2.591, P=0.015). There were not significant differences in blood losses [(325.00±64.30)ml vs. (356.67±49.52)ml; t=-1.490, P=0.147], the numbers of lymph nodes [(10.73±4.83) vs. (10.36±5.31); t=0.238, P=0.813], hospital stays [(15.32±3.69)d vs. (16.45±3.80)d; t=-1.005, P=0.320] and pathologic stages (P=0.713) in the gastric tube group and whole stomach group. The incidence of gastroesophageal reflux in the gastric tube group was significantly less than that in the whole stomach group, with a significant difference (1.96% vs. 15.22%; χ2=5.617, P=0.025). The occurrence of the complications like anastomotic leakage (5.88% vs. 10.87%; χ2=0.795, P=0.471), postoperative pulmonary complications (13.73% vs. 23.91%; χ2=1.661, P=0.296) and anastomotic stenosis (7.84% vs. 13.04%; χ2=0.707, P=0.510) had no statistical difference in the gastric tube group and whole stomach group. Conclusion In the surgical treatment of esophageal cancer, tubular stomach substitute for esophagus anastomosis is better than the full stomach substitute for esophageal surgery, which can improve the life quality of postoperative patients and is worthy of clinical promotion. Key words: Esophageal neoplasms; Gastroesophageal reflux; Gastric tube

Postoperative quality of life for patients with hypertensive cerebral hemorrhage in the basal ganglia

Objective To explore the life quality of postoperative patients after a hypertensive cerebral hemorrhage in the basal ganglia and the factors influencing it, so as to provide evidence for improving the life quality of such patients. Methods A total of 128 patients were studied retrospectively. Their gender, age, occupation, marital status, education level, place of residence and family size were tabulated, as well as whether or not they were living with their children, smoking or drinking alcohol. Their household income was recorded along with their clinical condition during surgery (midline shift, blood loss, operative time, whether a hernia occurred, consciousness, and whether bleeding broke into the ventricles. The SF-36 health measurement scale was used to evaluate the patients′ life quality, and the factors influencing it were analyzed. Results Univariate analysis showed that: (1) Their physiological functioning (PF) and global health (GH) were mainly affected by age, marital status, family size, midline shift, quantity of cerebral hemorrhage, occurrence of herniation, consciousness and whether the hemorrhage broke into the ventricles. (2) Their physiological role (RP) was influenced by marital status, education background, household monthly income, midline shift, consciousness and whether the hemorrhage broke into the ventricles. (3) Pain (BP) was mainly affected by marital status and family size. (4) Social functioning (SF) was closely related to marital status, family size, consciousness and whether hemorrhage broke into the ventricles. (5) Their mental health (MH) was mainly affected by the amount of bleeding, whether they were living with their children, the operation′s duration and whether the hemorrhage broke into the ventricles. (6) Their emotions (RE) were influenced by their consciousness and whether bleeding broke into the ventricles. (7) Their vitality (VT) was affected by their marital status, smoking, consciousness and whether the bleeding broke into the ventricles. Multivariate analysis showed that whether the hemorrhage broke into the ventricles was the most influential factor. Family size was also influential. Conclusions Age, number of family members, whether they are living with their children, and whether hemorrhage broke into the ventricles are all influential in predicting the life quality of survivors of hypertensive cerebral hemorrhage in the basal ganglia. Key words: Hypertension; Cerebral hemorrhage; Basal ganglia; Postoperative patients; Quality of life

Reconstruction with Jejunal Pouch after Gastrectomy for Gastric Cancer

The construction of a gastric substitute pouch after gastrectomy for gastric cancer has been proposed to help ameliorate postprandial symptoms and nutritional performance. Adequate reconstruction after gastrectomy is an important issue, because postoperative patient quality of life (QOL) primarily depends on the reconstruction method. To this end, jejunal pouch (JP) reconstructions were developed to improve the patient's eating capacity and QOL by creating large reservoirs with improved reflux barriers to prevent esophagitis and residual gastritis. It is important that such reconstructions also preserve blood and extrinsic neural integrity for maintaining pouch function, because JP motility is associated directly with QOL. Some problems remain to be resolved with the JP reconstructions method including gastrointestinal motility, which plays a major role in food transfer, digestion, and absorption of nutrients. Further studies including basic research and larger prospective randomized control trials are also needed to obtain definitive results. With persistent innovations in surgical techniques, JP after gastrectomy could become a safe and preferable reconstructive modality to improve patient QOL after gastrectomy.

The impact of complications on quality of life following colorectal surgery: a prospective cohort study to evaluate the Clavien-Dindo classification system.

This prospective cohort study was performed to evaluate the impact of complications on quality of life (QOL) in colorectal surgery. The Clavien-Dindo complication classification (CDCC) is promising, but has not been evaluated by relating the classification to patient-reported outcome measures. Patients undergoing colorectal surgery were evaluated prospectively 12months postoperatively using the WHOQOL-BREF questionnaire. Patient data were prospectively recorded and complications were classified using the CDCC. Postoperative QOL in patients with minor and severe complications and patients without complications was compared using a general linear model. Relationships between CDCC and QOL were examined using correlations and multivariate regression. Of 218 patients, 130 (59.6%) had complications. In patients with severe complications there was a greater decrease in overall QOL (P=0.043), QOL-physical (P<0.001) and QOL-psychological (P=0.013) domains in the first six postoperative weeks, whereas patients with minor complications had QOL scores comparable to those of patients without complications. QOL recovered to preoperative levels in all groups at 12months. Change in QOL at 6weeks was significantly correlated with CDCC grade, especially in the physical domain (Spearman's rho -0.287, P<0.001). The presence of severe complications was an independent predictor of overall QOL, QOL-physical and QOL-psychological at 6weeks. Severe complications are associated with reduced postoperative QOL at 6weeks, but QOL recovers after 12months. CDCC grade negatively correlates with change in QOL in the early postoperative period. These findings support the theoretical framework of the CDCC.

Analysis of postoperative life quality and influence factors of patients with hematopoietic stem cell transplantation

Objective To investigate the life quality of postoperative patients with hematopoietic stem cell transplantation (HSCT) and analyze its influencing factors, thus putting forward suggestions for follow-up visits and intervention of postoperative patients with HSCT. Methods A total of 64 cases of postoperative patients with HSCT in Beijing University Shenzhen Hospital and 36 cases of postoperative patients with HSCT in Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University were chosen as research objects from October 2003 to October 2013. The General Information Questionnaire and the World Health Organization Quality of Life-Brief (WHOQOL-BREF) were adopted to investigate the patients' quality of life. The General Information Questionnaire included gender, age, marital status, education level, disease types, the severity of graft versus host disease (GVHD), the types of transplantation, transplantation time and so on. The WHOQOL-BREF included four dimensions: physiological, psychological, environmental and social relations dimension. It consisted of 26 items and each item was one to five scores, the full mark was 130 scores. The survey results about postoperative life quality of patients with HSCT were analyzed by univariate analysis and multivariate analysis. The study protocol was approved by the Ethical Reviews Board of Investigation in Human Being of Beijing University Shenzhen Hospital and Sun Yat-Sen Memorial Hospital. Informed consent was obtained from all participants. Results ①The life quality scores of 100 patients were from 61 to 124 scores and the average scores was (96.6±12.1) scores which was in the medium level. The score of economic status item was lowest, only 15% patients thought that their economic conditions could meet the needs of treatment cost. ②Univariate analysis results showed that the quality of life after transplantation was closely related to these influencing factors: the transplant type, severity of GVHD, time after transplantation, working conditions and financial situation (P<0.05). The multiple linear regression analysis results of the 4 dimensions in WHOQOL-BREF showed that the descending order of influencing degree on the patients' quality of life after HSCT was physiological field, psychological field, environmental field and social relations field. Physiological field dimension was the most relevant dimension with patients' quality of life among four dimensions (R2=0.815, P=0.000). Conclusions The life quality of HSCT postoperative survivors is not high which should be improved. It prompts medical workers to strengthen the follow-up visits and take some corresponding intervention measures to maximally reduce their body pain, meet their spiritual needs, in order to improve the life quality of patients after HSCT operation. Key words: Hematopoietic stem cell transplantation; Quality of life; Influential factor

Clinical efficacy of anus-preserving operation for ultra low rectal cancer

Objective To investigate the clinical value of anus-preserving operation for ultra low rectal cancer. Methods The clinical data of 226 patients with ultra low rectal cancer who were admitted to the Yijishan Hospital between January 2009 and September 2013 were retrospectively analyzed. All the patients were divided into the anus-preserving group (117 patients underwent traditional or modified Dixon operation) and the control group (109 patients underwent Miles operation) . The operation time, volume of intraoperative blood loss, number of lymph node dissection, recovery time of intestinal function, postoperative short-term amplications, local recurrence and distal metastasis of tumors, survival rate and quality of life in the 2 groups were analyzed. The measurement data with normal distribution were presented as ±s and analyzed using t test, count data were analyzed using Pearson chi-square test. The survival curve was drawn by Kaplan-Meier method, and the survival rate was analyzed using the Log-rank test. The patients were followed up by regular out-patient examination and telephone interview up to September 2014. Results The traditional Dixon operation was performed on 108 patients, modified Dixon operation on 9 patients and Miles operation on 109 patients in the control group. The operation time and volume of blood loss were (117 ± 12) minutes and (110 ± 51) mL in the anus-preserving group, which were significantly different from (122 ± 8) minutes and (155 ± 44) mL in the control group ( t =3. 80, 7. 09 , P 0.05 ) . Among the 184 patients receiving postoperative chemotherapy, 19 patients terminated the chemotherapy due to serious response to chemotherapy, 17 patients received radiotherapy after chemotherapy, 9 patients received interventional treatment for liver after chemotherapy and 42 patients didn't receive the chemotherapy. The incidence of perianal eczema were 15. 38% (18/117) in the anus-preserving group and 3. 67% (4/109) in the control group, with a significant difference between the 2 groups (χ2 =8. 81, P 0. 05) . One-hundred and ninety patients were followed up for a median time of 34. 5 months (range, 12. 0-57. 0 months) . The rate of local tumor recurrence, rate of distant metastasis and 1-and 3-year survival rate were 8.55% (10/117) , 5. 98% (7/117) , 94.8% and 76. 2% in the anus-preserving group and 8.26% (9/109) , 5.50% (6/109) , 95.7% and 76.1% in the control group, with no significant difference between the 2 groups (χ2=0. 01 , 0. 02, 0. 08, 0. 00, P >0. 05) . The score of life quality was 66 ± 14 in the anus-preserving group, which was significantly higher than 49 ± 11 in the control group ( t =10. 13 , P <0. 05) . Conclusion The anus-preserving operation for ultra low rectal cancer is safe and feasible based on strictly grasping operative indications , meanwhile, it can improve the postoperative life quality of patients. Key words: Rectal neoplasms, ultra low; Anus-preserving operation; Low anterior resection of the rectum

Influence of sexual function intervention on quality of sexual life for patients after LuohuII surgery

Objective The Female Sexual Function Index (FSFI) was used to investigate the sexual life quality of patients who got laparoscopic peritoneal vaginoplasty of LuohuⅡ, so as to take measures to improve patients postoperative quality of life. Methods A total of 106 cases undergoing laparoscopic peritoneal vaginoplasty of LuohuⅡ were selected from January 2012 to March 2013.All patients got the questionnaire survey by FSFI and the FSDS-R questionnaire to evaluate the sexual function and psychological states. According to the existing problems, the intervention measures and health guidance were given to patients. And one year after surgery, their sexual function was evaluated again. Results The length of vagina was (12.29±1.67) cm, which was significantly longer than before (t=2.825, P<0.05). The sexual desire, sexual arousal, sexual orgasm, sexual satisfaction, sexual pain and total score of FSFI were (4.0±0.4), (4.2±0.4), (4.5±0.5), (4.1±0.7), (5.0±0.5), (4.6±0.5) and (29.7±1.2), which were significantly better than those before (t=7.64, 3.77, 6.27, 8.14, 8.78, 7.92, 36.13, respectively; P<0.01). Conclusions The sexual satisfaction of patients is increased after intervention. The patients with laparoscopic peritoneal vaginoplasty generally have sex problems and lack of the confidence, and effective intervention can improve the sexual life quality and satisfaction, as well as self-confidence of patients. Key words: Laparoscopic peritoneal vaginoplasty; LuohuⅡ; Quality of sexual life; Satisfaction