胰腺切除术后患者短期生活质量的前瞻性观察研究
发布时间：2018-10-25 19:18
【摘要】：背景胰腺癌是消化系统恶性程度较高的肿瘤之一,其5年生存率仅为5%。根治性手术切除肿瘤是目前唯一可能延长生存时间的治疗措施。传统医疗方法只关注死亡和疾病缓解,忽视了病人对疾病和治疗在心理状态、主观感受、生理功能、家人关系和社会角色等方面的影响。并发症发生率、死亡率和肿瘤复发率往往作为评估胰腺癌术后预后的指标。然而随着对患者主观感受的研究重视,生活质量(quality of life,QOL)也逐渐被认可作为评估手术疗效的重要指标之一。目的手术治疗是唯一可以根治胰腺癌的治疗方法,但生存时间并不理想,因此胰腺术后的生活质量和生存时间同样重要。目前国内关于胰腺切除术后的生活质量的研究鲜见报道,本中心率先在国内前瞻性地研究胰腺手术患者的短期生活质量变化。方法前瞻性分析2016年1月-2016-10月在南京军区南京总医院行胰腺切除手术患者,利用欧洲癌症研究与治疗组织(European Organization for Research and Treatment of Cancer,EORTC)开发的生活质量测定量表(QLQ-C30)和胰腺疾病特异性问卷调查表(QLQ-PAN26)评估患者术前和术后第1、2、3、6月的生活质量评分。结果2016年1月-2016年10月共93例患者于南京军区南京总医院行胰腺切除术,其中入组72例。所有功能领域得分在术后1月评分同术前相比明显下降(P0.05)。术后3月角色功能、情绪功能和认知功能同术前相比均成显著下降(P0.05)。术后6月的所有功能领域已基本恢复至术前,得分同术前相比已无统计学差异(P0.05),其中接近80%的患者恢复至术前基线。术后1月、2月、3月和6月的总健康状况与术前相比均显著上升,P0.05。术后1月的饮食习惯改变、食欲丧失、便秘、疲倦、气促、恶液质症状均较术前加重(P0.05)。但肝损害、腹腔积液领域在术后症状改善,术后2月与术前基线相比改善明显(P0.05)。E0RTCQLQ-C30问卷疼痛领域在术后3月和术后6月同术前相比评分明显下降,P0.05;EORTC QLQ-PAN26问卷疼痛领域在术后3月与术前相比才下降明显,P0.05。结论胰腺切除手术后患者生活质量短期内出现不同程度的下降,但随后逐步改善,术后3-6月生活质量可恢复至术前,部分领域甚至优于术前。
[Abstract]:Background Pancreatic carcinoma is one of the most malignant tumors in the digestive system. The 5-year survival rate is only 5%. Radical resection of tumor is the only treatment that can prolong survival time. Traditional medical methods only focus on death and disease relief, ignoring the influence of patients on mental state, subjective feeling, physiological function, family relationship and social role. The incidence of complications, mortality and tumor recurrence rate are often used as indicators to evaluate postoperative prognosis of pancreatic cancer. However, with the study of patients' subjective feelings, quality of life (quality of life,QOL) has gradually been recognized as one of the important indicators to evaluate the outcome of surgery. Objective Surgical treatment is the only way to cure pancreatic cancer, but the survival time is not ideal, so the quality of life and survival time after pancreatic surgery are equally important. At present, there are few reports about the quality of life after pancreatectomy in our country. Our center has taken the lead in studying the short-term quality of life of patients undergoing pancreatic surgery in China. Methods from January 2016 to October 2016, patients undergoing pancreatic resection in Nanjing General Hospital of Nanjing military region were analyzed prospectively. (European Organization for Research and Treatment of Cancer, was used as a tissue for cancer research and treatment in Europe. The quality of life scale (QLQ-C30) developed by EORTC and the Pancreatic Disease specificity questionnaire (QLQ-PAN26) were used to evaluate the QOL scores of the patients before and after operation. Results from January 2016 to October 2016, 93 patients underwent pancreatectomy in Nanjing General Hospital of Nanjing military region, including 72 cases. The scores of all functional areas decreased significantly in 1 month after operation compared with those before operation (P0.05). Role function, emotional function and cognitive function decreased significantly 3 months after operation (P0.05). After 6 months, all functional areas had recovered to preoperative, and the scores had no statistical difference compared with pre-operation (P0.05), and nearly 80% of the patients recovered to the baseline before operation. The total health status in 1 month, 2 month, 3 month and 6 month after operation was significantly higher than that before operation (P 0. 05. 0. 05). The changes of diet habits, loss of appetite, constipation, tiredness, shortness of breath, and symptoms of cachexia were all worse than those before operation (P0.05). However, the postoperative symptoms in the area of intraperitoneal effusion were improved in the area of liver injury, and the baseline was significantly improved at 2 months after operation (P0.05). The scores in pain area of E0RTCQLQ-C30 questionnaire decreased significantly in 3 months after operation and 6 months after operation compared with preoperative scores (P0.05). The pain area of EORTC QLQ-PAN26 questionnaire decreased significantly 3 months after operation compared with preoperation (P 0.05). Conclusion the quality of life of the patients after pancreatic resection was decreased in a short period of time, but then gradually improved, and the quality of life could be recovered to preoperative in 3 to 6 months postoperatively, and in some areas was even better than that before operation.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.9
，
本文编号：2294591
[Abstract]:Background Pancreatic carcinoma is one of the most malignant tumors in the digestive system. The 5-year survival rate is only 5%. Radical resection of tumor is the only treatment that can prolong survival time. Traditional medical methods only focus on death and disease relief, ignoring the influence of patients on mental state, subjective feeling, physiological function, family relationship and social role. The incidence of complications, mortality and tumor recurrence rate are often used as indicators to evaluate postoperative prognosis of pancreatic cancer. However, with the study of patients' subjective feelings, quality of life (quality of life,QOL) has gradually been recognized as one of the important indicators to evaluate the outcome of surgery. Objective Surgical treatment is the only way to cure pancreatic cancer, but the survival time is not ideal, so the quality of life and survival time after pancreatic surgery are equally important. At present, there are few reports about the quality of life after pancreatectomy in our country. Our center has taken the lead in studying the short-term quality of life of patients undergoing pancreatic surgery in China. Methods from January 2016 to October 2016, patients undergoing pancreatic resection in Nanjing General Hospital of Nanjing military region were analyzed prospectively. (European Organization for Research and Treatment of Cancer, was used as a tissue for cancer research and treatment in Europe. The quality of life scale (QLQ-C30) developed by EORTC and the Pancreatic Disease specificity questionnaire (QLQ-PAN26) were used to evaluate the QOL scores of the patients before and after operation. Results from January 2016 to October 2016, 93 patients underwent pancreatectomy in Nanjing General Hospital of Nanjing military region, including 72 cases. The scores of all functional areas decreased significantly in 1 month after operation compared with those before operation (P0.05). Role function, emotional function and cognitive function decreased significantly 3 months after operation (P0.05). After 6 months, all functional areas had recovered to preoperative, and the scores had no statistical difference compared with pre-operation (P0.05), and nearly 80% of the patients recovered to the baseline before operation. The total health status in 1 month, 2 month, 3 month and 6 month after operation was significantly higher than that before operation (P 0. 05. 0. 05). The changes of diet habits, loss of appetite, constipation, tiredness, shortness of breath, and symptoms of cachexia were all worse than those before operation (P0.05). However, the postoperative symptoms in the area of intraperitoneal effusion were improved in the area of liver injury, and the baseline was significantly improved at 2 months after operation (P0.05). The scores in pain area of E0RTCQLQ-C30 questionnaire decreased significantly in 3 months after operation and 6 months after operation compared with preoperative scores (P0.05). The pain area of EORTC QLQ-PAN26 questionnaire decreased significantly 3 months after operation compared with preoperation (P 0.05). Conclusion the quality of life of the patients after pancreatic resection was decreased in a short period of time, but then gradually improved, and the quality of life could be recovered to preoperative in 3 to 6 months postoperatively, and in some areas was even better than that before operation.
【学位授予单位】：南京大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.9
，
本文编号：2294591
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