Gesundheitsbezogene Lebensqualität nach operativer Hämorrhoidaltherapie – Ergebnisse, Methoden und Probleme

 

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Zusammenfassung

Bei einer Hyperplasie des Corpus cavernosum recti und Vorliegen einer analen Beschwerdesymptomatik, die aus transanaler Blutung, perianalem Pruritus, Nässen, Stuhlschmieren oder der Wahrnehmung eines Druck- oder Fremdkörpers bestehen kann, spricht man von einem Hämorrhoidalleiden. Je nach morphologischer Veränderung unterscheidet man zwischen Hämorrhoiden I°, II°, III° und IV°. Die Therapieoptionen werden an den Schweregrad der Erkrankung angepasst und bestehen in den frühen Stadien aus konservativen Maßnahmen wie Stuhlregulation, Sklerosierung und Gummibandligaturen, in den fortgeschrittenen Stadien werden operative Verfahren (z. B. die Segmentexzision und die Staplerhämorrhoidopexie) angewendet. Die gesundheitsbezogene Lebensqualität wird zunehmend häufiger als Qualitätsmerkmal einer konservativen oder operativen Therapie definiert. Nicht nur die morphologische und funktionelle Wiederherstellung von Körperstrukturen oder -funktionen, sondern die subjektive Einschätzung der Beschwerdebesserung durch den Patienten wird als relevanter Behandlungserfolg gewertet. Entsprechend wird dieses Kriterium zunehmend als primärer oder sekundärer Endpunkt klinischer Studien gewählt. Trotz der hohen Inzidenz des Hämorrhoidalleidens, die mit jährlich 4 % in Industrienationen angegeben wird, und aus der in Deutschland 40 000–50 000 operative Eingriffe und ca. 3,5 Millionen Behandlungsfälle pro Jahr resultieren, liegen nur sehr limitierte Daten zur Beeinflussung der Lebensqualität durch diese Erkrankung vor. Auch aus gesundheitspolitischen Aspekten gewinnt die Kosten-Nutzwert-Analyse unter Verwendung des Maßes der lebensqualitätsadjustierten Lebensjahre zunehmend an Bedeutung. In der vorliegenden Arbeit werden Definitionen der gesundheits- und krankheitsbezogenen Lebensqualität erläutert. Die zur Verfügung stehenden psychometrischen Instrumente zur Lebensqualitätsmessung werden dargestellt und deren Qualitätskriterien und Grenzen diskutiert. 

Abstract

In patients suffering from haemorrhoidal disease a hyperplasia of the corpus cavernosum recti is accompanied by various symptoms such as anal bleeding and minor continence disorders as well as itching, soiling and burning. According to the morphological findings, haemorrhoids are staged from grade I up to IV. Therapy strategies are adjusted to this staging. Early stages are treated by conservative measures, such as regulation of defaecation, sclerosis and rubber band ligations. Advanced stages require operative methods, such as segmental excision and stapled haemorrhoidopexy. Since patients demand a greater regard to the subjective experience of their disease and its treatment, quality of life evaluation has become an important issue in medical care. Therefore health-related quality of life is increasingly becoming a relevant primary or secondary end point of clinical studies. Since up to 4 % of the general adult population in industrial nations is annually diagnosed to suffer from haemorrhoidal disease, in Germany per annum 3.5 Mio patients seek medical advice due to this condition and 40 000–50 000 surgical procedures are performed. Nevertheless only very few studies have been carried out to investigate the influence of this widespread disease on the quality of life of those patients. Additionally cost-effectiveness analyses measuring quality-adjusted life years are becoming more and more decisive in health politics. The present article discusses the definitions of health-related as well as disease-related quality of life. Different psychometric tests applied to evaluate the quality of life are summarised, quality criteria are outlined and limitations discussed. Several studies were analysed in regard to the quality of life in patients with haemorrhoidal disease and the specific influence of different operative techniques was reviewed. 

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