45-50岁子宫肌瘤患者腹腔镜下不同术式生活质量调查及卫生经济学分析
发布时间：2019-07-05 14:48
【摘要】：研究背景： 子宫肌瘤是女性生殖器官最常见的良性肿瘤，发生率20—30%，多见于30—50岁女性。子宫肌瘤可采用手术疗法和非手术疗法，但迄今尚未发现疗效确切、可有效避免或控制复发的非手术疗法，因此手术疗法仍是当前子宫肌瘤患者的最常用的治疗措施。腹腔镜现已成为妇科手术主要的途径。腹腔镜手术治疗子宫肌瘤可选择肌瘤剔除术和子宫切除术，既往45岁以上的子宫肌瘤患者多采用子宫切除术，在去除原发病的同时杜绝了子宫病变的发生，随着宫颈疾病筛查的普及、宫腔镜子宫内膜病变的检查和治疗，子宫病变能够早期发现和治疗。随着生活水平的提高，对生活质量的要求也更高了，越来越多的人重视子宫的去留问题，绝经过渡期或绝经期患者亦希望保留子宫。采取何种手术方式是医患双方共同关注的问题。尤其对于已经完成生育的绝经过渡期子宫肌瘤患者，，究竟选择何种术式更符合患者的生理和心理要求尚无定论。对绝经过渡期女性不同术式术后生活质量的关注及调查目前尚缺乏。注重生活质量的提高，更能体现以人为本的医学理念。对患者进行生活质量的调查评价和不同术式卫生经济学评价，是了解患者疾病负担和评估疗效的新方法。 研究目的： 通过对45-50岁子宫肌瘤患者手术治疗前后进行SF-36生活质量问卷调查及绝经过渡期症状和性生活质量研究，了解腹腔镜子宫肌瘤剔除术和腹腔镜全子宫切除术这两种术式对绝经过渡期子宫肌瘤患者术后生活质量的影响、分析其可能原因，并对两种手术的费用和住院时间进行比较和卫生经济学评价，从而在选择术式及预测术后生活质量方面给与指导，探索出一条针对绝经过渡期子宫肌瘤患者科学、行之有效的手术方法，使生理-心理-社会医学模式在妇科临床中得到推广应用。 研究对象： 选取2013.1.1--2013.7.31因子宫肌瘤于大连市妇产医院住院行腹腔镜手术治疗的患者。年龄45—50周岁，月经规律，超声提示肌瘤≤5枚，做病情沟通后根据个人意愿选择肌瘤剔除术或全子宫切除术。术前三个月内未应用激素相关治疗，术前诊刮除外内膜病变，术后病理证实为子宫平滑肌瘤。行腹腔镜子宫肌瘤剔除术患者30例，，腹腔镜全子宫切除术患者30例。 研究方法： 主问卷为SF-36测量表，辅助问卷为绝经过渡期症状调查表和性生活调查表，统计患者住院时间和花费。所有患者入院后手术前及术后6月填写，回收问卷，对施行不同手术的患者术后生活质量进行评价。问卷评分遵循其系统计分方法。数据统计学分析采用SPSS13.0软件包。统计学方法采用t检验或卡方检验，信度效度分析。P0.05为差异有统计学意义。 结果： 1、SF-36生活质量测量量表应用于子宫肌瘤患者并对其进行生活质量的评价具有可行性，效果良好。 2、SF-36总分两组患者术前比较无差异（p0.05），腹腔镜子宫肌瘤剔除组术后SF-36评分高于术前（p0.05），而腹腔镜全子宫切除组术后评分低于术前（p0.05），术后腹腔镜子宫肌瘤剔除组的总分明显高于腹腔镜全子宫切除组（p0.05）。 3、SF-36各维度评分两组术前比较无差异（p0.05),腹腔镜子宫肌瘤剔除组术后躯体职能、一般健康感、社交功能、情感职能和精神健康5个维度评分高于术前（p0.05），腹腔镜全子宫切除组术后躯体机能、躯体职能、一般健康感、社交功能、情感职能和精神健康6个维度评分均低于术前，且低于腹腔镜子宫肌瘤剔除组（p0.05）。 4、绝经过渡期症状发生率两组术前比较无差异（p0.05),腹腔镜全子宫切除术患者术后6月潮热、焦虑/忧郁和疲劳乏力的绝经过渡期症状发生率高于腹腔镜子宫肌瘤剔除术患者（p0.05）。 5、性生活质量两组术前比较无差异（p0.05)，腹腔镜子宫肌瘤剔除组术后性生活质量与术前比较无差异（p0.05)，但腹腔镜全子宫切除组手术后性欲降低、阴道干燥和性焦虑的发生率高于术前，且高于腹腔镜子宫肌瘤剔除组（p0.05)。 6、腹腔镜子宫肌瘤剔除组的平均住院时间、平均术后住院时间、手术费和药费低于腹腔镜全子宫切除组（p0.05）。 结论： 对于45-50岁子宫肌瘤患者： 1、SF-36生活质量测量量表可以应用于子宫肌瘤患者生活质量的测量及评价，具有良好的性能。 2、腹腔镜子宫肌瘤剃除术患者术后6月的总体生活质量高于采用腹腔镜全子宫切除术患者。 3、腹腔镜子宫肌瘤剔除术提高了术后患者的生活质量，而腹腔镜全子宫切除术后患者的生活质量降低，患者的生理健康和心理健康均受影响。 4、腹腔镜全子宫切除组患者术后6月绝经过渡期症状发生率高于腹腔镜子宫肌瘤剔除术患者。 5、腹腔镜子宫肌瘤剔除术对患者术后性生活质量无不良影响，腹腔镜全子宫切除术患者术后性生活质量低于术前，并低于腹腔镜子宫肌瘤剔除术后患者。 6、腹腔镜子宫肌瘤剔除术的住院时间和医疗花费均低于腹腔镜全子宫切除术。 7、腹腔镜子宫肌瘤剔除术患者较腹腔镜全子宫切除术患者术后有更高的生活质量，对绝经过渡期和性生活质量的影响小，经济花费少，值得临床推广。
[Abstract]:Study Background: Hysteromyoma is the most common benign tumor of female reproductive organs, with a rate of 20% and 30%, which is found in 30-50-year-old women. Sex. Hysteromyoma can be used for surgical and non-operative treatment, but so far, it has not been found that the curative effect is definite, can effectively avoid or control the non-operative treatment of the recurrence, so the operation therapy is still the most commonly used treatment measure in the patients with the current uterine fibroids. Application. The laparoscope has now become the main course of the gynecological operation. diameter. The laparoscopic operation for the treatment of hysteromyoma can be used for the selection of myomectomy and hysterectomy, and a hysterectomy is used in the patients with the uterine fibroids with the previous 45-year-old, and the occurrence of the uterine lesion is eliminated while the original disease is removed, and as the screening of the cervical diseases And the detection and treatment of the endometrial lesions of the hysteroscope, which can be found and treated in an early stage. With the improvement of the living standard, the demand for quality of life is also higher, and more and more people pay more attention to the problem of the retention of the uterus. The way of operation is the question of mutual interest between the doctor-patient and the doctor-patient In particular, in the case of postmenopausal women with uterine fibroids who have completed the birth, the choice of surgical procedure is more consistent with the physiological and psychological requirements of the patient. A Study on the Quality of Life of Postmenopausal Women with Different Methods of Operation and Investigation Spent. Pay attention to the improvement of the quality of life, and more embody the people-oriented medical science. The investigation and evaluation of the quality of life of the patient and the evaluation of the health economics of different operation procedures are the new prescription for understanding the burden of the disease and evaluating the curative effect of the patients. A. Research Objective: To investigate the quality of life quality of SF-36 before and after the operation of 45-50-year-old patients with hysteromyoma and the symptoms and sex of post-menopausal transition. To study the effect of laparoscopic myomectomy and laparoscopic total hysterectomy on the quality of life in the post-menopausal women with uterine fibroids. Economic evaluation, so as to provide guidance on the choice of operation and the quality of life after operation, and to explore a scientific and effective operation method for the patients with uterine fibroids in the transition period, and make the physiological-psychological-social medical pattern in the clinical of the gynaecology. to popularization and application . Study object: select 2013.1.1--2013.7.31 to be hospitalized for uterine fibroids in the hospital of Dalian Maternity Hospital The patients with endoscopic surgical treatment. The age of 45 to 50 years of age, the rule of menstruation, the ultrasound of 5 of the uterine fibroids, and after the communication, the myomectomy was selected according to the individual's wishes. Intraoperative or full-hysterectomy. No hormone-related treatment was applied in the first three months, except for pre-operative diagnosis of endometrial lesions, post-operative pathology, It is proved to be a leiomyoma of the uterus. The patients with eclectomy The study method: The main questionnaire is SF-36 measurement table, and the auxiliary questionnaire is the symptom questionnaire and the sex life investigation of the post-menopausal transition period. Table, Statistical patient's hospital stay and time spent. All patients were completed before and after the operation and completed in June. The questionnaire was collected and different procedures were performed. The quality of life after operation was evaluated. The score of the questionnaire follows the system scoring method. The data statistics analysis The SPSS 13.0 software package is used. The statistical method uses t-test Test or chi-square test, reliability and validity analysis. P 0.0 5. The results were as follows:1. The SF-36 life quality measurement scale was applied to the patients with hysteromyoma and performed them. The evaluation of life quality was feasible and the effect was good. There was no difference between the two groups of SF-36 total score (p0.05). The SF-36 score after laparoscopic myomectomy was higher than that before operation (p0.05). The postoperative score of the hysterectomy group was lower than that before operation (p0.05), and the total number of the laparoscopic myomectomy group was clear after operation. The scores of physical function, general health, social function, emotional function and mental health were higher than that before operation (p <0.05). 0.05) The body function, physical function, general health, social function, emotional function and mental health of the total hysterectomy group were lower than before. At the same time, it was lower than that of the laparoscopic myomectomy group (p0.05).4. There was no difference between the two groups before operation (p0.05). The rate of life was higher than that of laparoscopic myomectomy (p0.05).5. There was no difference between the two groups before operation (p0.05). The quality of sexual life after laparoscopic myomectomy was no difference (p0.05). The incidence of sexual desire reduction, vaginal dryness and sexual anxiety after group operation The mean hospital stay in the laparoscopic myomectomy group was higher than that of the laparoscopic myomectomy group (p0.05). The average postoperative hospital stay was higher than that of the laparoscopic myomectomy group (p0.05). time, The operating expenses and the medical expenses are lower than the total laparoscopic hysterectomy de-group (p0.05). Conclusion:1, SF-36 quality of life for patients with uterine fibroids of 45-50 years The measurement scale can be applied to the measurement and evaluation of the quality of life of the patients with hysteromyoma, and has good performance. The overall quality of life of the patients with hysteromyoma was higher than that of patients with laparoscopic total hysterectomy.3. The laparoscopic myomectomy increased the quality of life of patients after operation. And the quality of life of the patients after laparoscopic total hysterectomy is reduced, and the physiological and mental health and mental health of the patients are affected. The incidence of the post-operation of the patients with laparoscopic total hysterectomy was higher than that of the patients with laparoscopic myomectomy. In response, the quality of sexual life after laparoscopic total hysterectomy was lower than that before operation and lower than that of laparoscopic myomectomy. 6. The time and cost of the laparoscopic myomectomy were lower than that of the laparoscopic total hysterectomy.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33
本文编号：2510603
[Abstract]:Study Background: Hysteromyoma is the most common benign tumor of female reproductive organs, with a rate of 20% and 30%, which is found in 30-50-year-old women. Sex. Hysteromyoma can be used for surgical and non-operative treatment, but so far, it has not been found that the curative effect is definite, can effectively avoid or control the non-operative treatment of the recurrence, so the operation therapy is still the most commonly used treatment measure in the patients with the current uterine fibroids. Application. The laparoscope has now become the main course of the gynecological operation. diameter. The laparoscopic operation for the treatment of hysteromyoma can be used for the selection of myomectomy and hysterectomy, and a hysterectomy is used in the patients with the uterine fibroids with the previous 45-year-old, and the occurrence of the uterine lesion is eliminated while the original disease is removed, and as the screening of the cervical diseases And the detection and treatment of the endometrial lesions of the hysteroscope, which can be found and treated in an early stage. With the improvement of the living standard, the demand for quality of life is also higher, and more and more people pay more attention to the problem of the retention of the uterus. The way of operation is the question of mutual interest between the doctor-patient and the doctor-patient In particular, in the case of postmenopausal women with uterine fibroids who have completed the birth, the choice of surgical procedure is more consistent with the physiological and psychological requirements of the patient. A Study on the Quality of Life of Postmenopausal Women with Different Methods of Operation and Investigation Spent. Pay attention to the improvement of the quality of life, and more embody the people-oriented medical science. The investigation and evaluation of the quality of life of the patient and the evaluation of the health economics of different operation procedures are the new prescription for understanding the burden of the disease and evaluating the curative effect of the patients. A. Research Objective: To investigate the quality of life quality of SF-36 before and after the operation of 45-50-year-old patients with hysteromyoma and the symptoms and sex of post-menopausal transition. To study the effect of laparoscopic myomectomy and laparoscopic total hysterectomy on the quality of life in the post-menopausal women with uterine fibroids. Economic evaluation, so as to provide guidance on the choice of operation and the quality of life after operation, and to explore a scientific and effective operation method for the patients with uterine fibroids in the transition period, and make the physiological-psychological-social medical pattern in the clinical of the gynaecology. to popularization and application . Study object: select 2013.1.1--2013.7.31 to be hospitalized for uterine fibroids in the hospital of Dalian Maternity Hospital The patients with endoscopic surgical treatment. The age of 45 to 50 years of age, the rule of menstruation, the ultrasound of 5 of the uterine fibroids, and after the communication, the myomectomy was selected according to the individual's wishes. Intraoperative or full-hysterectomy. No hormone-related treatment was applied in the first three months, except for pre-operative diagnosis of endometrial lesions, post-operative pathology, It is proved to be a leiomyoma of the uterus. The patients with eclectomy The study method: The main questionnaire is SF-36 measurement table, and the auxiliary questionnaire is the symptom questionnaire and the sex life investigation of the post-menopausal transition period. Table, Statistical patient's hospital stay and time spent. All patients were completed before and after the operation and completed in June. The questionnaire was collected and different procedures were performed. The quality of life after operation was evaluated. The score of the questionnaire follows the system scoring method. The data statistics analysis The SPSS 13.0 software package is used. The statistical method uses t-test Test or chi-square test, reliability and validity analysis. P 0.0 5. The results were as follows:1. The SF-36 life quality measurement scale was applied to the patients with hysteromyoma and performed them. The evaluation of life quality was feasible and the effect was good. There was no difference between the two groups of SF-36 total score (p0.05). The SF-36 score after laparoscopic myomectomy was higher than that before operation (p0.05). The postoperative score of the hysterectomy group was lower than that before operation (p0.05), and the total number of the laparoscopic myomectomy group was clear after operation. The scores of physical function, general health, social function, emotional function and mental health were higher than that before operation (p <0.05). 0.05) The body function, physical function, general health, social function, emotional function and mental health of the total hysterectomy group were lower than before. At the same time, it was lower than that of the laparoscopic myomectomy group (p0.05).4. There was no difference between the two groups before operation (p0.05). The rate of life was higher than that of laparoscopic myomectomy (p0.05).5. There was no difference between the two groups before operation (p0.05). The quality of sexual life after laparoscopic myomectomy was no difference (p0.05). The incidence of sexual desire reduction, vaginal dryness and sexual anxiety after group operation The mean hospital stay in the laparoscopic myomectomy group was higher than that of the laparoscopic myomectomy group (p0.05). The average postoperative hospital stay was higher than that of the laparoscopic myomectomy group (p0.05). time, The operating expenses and the medical expenses are lower than the total laparoscopic hysterectomy de-group (p0.05). Conclusion:1, SF-36 quality of life for patients with uterine fibroids of 45-50 years The measurement scale can be applied to the measurement and evaluation of the quality of life of the patients with hysteromyoma, and has good performance. The overall quality of life of the patients with hysteromyoma was higher than that of patients with laparoscopic total hysterectomy.3. The laparoscopic myomectomy increased the quality of life of patients after operation. And the quality of life of the patients after laparoscopic total hysterectomy is reduced, and the physiological and mental health and mental health of the patients are affected. The incidence of the post-operation of the patients with laparoscopic total hysterectomy was higher than that of the patients with laparoscopic myomectomy. In response, the quality of sexual life after laparoscopic total hysterectomy was lower than that before operation and lower than that of laparoscopic myomectomy. 6. The time and cost of the laparoscopic myomectomy were lower than that of the laparoscopic total hysterectomy.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33
【参考文献】
相关期刊论文 前2条
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2 杨燕飞;傅锦媚;阮祥燕;;子宫肌瘤患病年龄分布与追踪研究[J];实用妇产科杂志;2008年05期
本文编号：2510603
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