乳癌术后乳房再造患者生命质量及满意度调查
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摘要
了解中国乳癌改良根治术后乳房再造术的患者的生命质量状况,以及其对乳房外观和手术相关内容的满意程度。通过对即刻和延期乳房再造术在组间及组内分层进行比较来研究患者特征与其生命质量及满意度的相关关系。
本研究采用国外相关研究使用最为广泛的健康调查简表(SF-36)作为生命质量的评测工具；采用了自行设计的满意度调查问卷,包括乳房一般外观自评和手术相关问题满意度两方面的内容。问卷中还附有知情同意书和患者一般情况收集表。根据研究的需要,我们对在北京协和医院完成手术的17名乳癌改良根治术后即刻乳房再造患者和20名乳癌改良根治术后延期乳房再造患者进行了问卷调查。本研究采用19名乳腺癌改良根治术后患者(连续病例)及84名不同职业的健康人群作为对照。
生命质量方面,行即刻乳房再造术患者、仅行乳腺癌改良根治术的患者组与健康人群组各维度得分之间没有显著性差异；延期组在生理功能、一般健康状况、精力和精神健康维度上的得分显著高于健康人群组；在一般健康状况、精力、精神健康维度上的得分显著高于即刻组；在生理功能和一般健康状况维度上的得分则显著高于未再造组。乳房一般外观自评方面,即刻组与延期组在乳房外观各方面评分上均无显著性差异,且均达到健康人群水平；两组在乳房外观各方面的评分均显著优于未行再造术的患者。即刻组和延期组在手术相关满意度方面均无显著性差异。在分层分析中,放疗能够对瘢痕情况、乳房大小和对称性产生显著负面影响,患者在与预期相符程度评分上也显著较低。即刻组中采用背阔肌皮瓣的患者对术前信息知晓程度的评分显著较低。
乳房再造术有利于乳癌改良根治术后的患者更好地康复,即刻和延期乳房再造术对患者术后的生命质量均未见负面影响,尤其能够对乳房外观的改善发挥巨大的作用,所以值得进一步的推广；延期再造术生命质量评分优于即刻再造术,提示应加强术前对即刻再造患者的心理状态评估和教育；术后放疗对乳房外观能产生显著的负面影响；患者对于不同手术方式的满意度相似。
The goal of the study is to investigate the health-related quality of life (HRQL) and patient satisfaction of Chinese breast cancer patients who underwent breast reconstruction, either immediate or delayed, after mastectomy.
Validated Simplified Chinese Edition of SF-36Health Survey was used to evaluate respondents' HRQL and a study specific questionnaire was used to evaluate respondents' satisfaction, including issues on cosmetic outcome and procedure-related aspects.17women with immediate reconstruction (IR),20with delayed reconstruction (DR) and19with mastectomy only were enrolled. Scores of the questionnaire were compared with age and educational level matched healthy women with different occupations.
In all8dimensions of SF-36, no significant difference was found between the mastectomy group, the IR group and the healthy control group; scores of the DR group in4dimensions out of8were significantly higher than the healthy control. The DR group also was superior to the IR group in3dimensions. There is no significant difference between the scores with regard to the satisfaction of the2reconstruction groups. Within every aspect of cosmetic outcome, the score of either reconstruction group was found to be significant higher than that of the mastectomy group, and scores of both IR and DR groups were comparable with that of the healthy control. Postoperative radiotherapy can negatively affect the appearance.
There was no untoward impact that IR and DR had on HRQL. Breast reconstruction could be of advantage to the rehabilitation after mastectomy for breast cancer patients, especially to the improvement of breast appearance. The DR group's scores of SF-36was superior to that of the IR group, indicating assessment of patients' psychological status before surgery was necessary. Radiotherapy had a negative impact on cosmetic outcome. Breast reconstruction using different methods can result in similar patient satisfaction.
本研究采用国外相关研究使用最为广泛的健康调查简表(SF-36)作为生命质量的评测工具；采用了自行设计的满意度调查问卷,包括乳房一般外观自评和手术相关问题满意度两方面的内容。问卷中还附有知情同意书和患者一般情况收集表。根据研究的需要,我们对在北京协和医院完成手术的17名乳癌改良根治术后即刻乳房再造患者和20名乳癌改良根治术后延期乳房再造患者进行了问卷调查。本研究采用19名乳腺癌改良根治术后患者(连续病例)及84名不同职业的健康人群作为对照。
生命质量方面,行即刻乳房再造术患者、仅行乳腺癌改良根治术的患者组与健康人群组各维度得分之间没有显著性差异；延期组在生理功能、一般健康状况、精力和精神健康维度上的得分显著高于健康人群组；在一般健康状况、精力、精神健康维度上的得分显著高于即刻组；在生理功能和一般健康状况维度上的得分则显著高于未再造组。乳房一般外观自评方面,即刻组与延期组在乳房外观各方面评分上均无显著性差异,且均达到健康人群水平；两组在乳房外观各方面的评分均显著优于未行再造术的患者。即刻组和延期组在手术相关满意度方面均无显著性差异。在分层分析中,放疗能够对瘢痕情况、乳房大小和对称性产生显著负面影响,患者在与预期相符程度评分上也显著较低。即刻组中采用背阔肌皮瓣的患者对术前信息知晓程度的评分显著较低。
乳房再造术有利于乳癌改良根治术后的患者更好地康复,即刻和延期乳房再造术对患者术后的生命质量均未见负面影响,尤其能够对乳房外观的改善发挥巨大的作用,所以值得进一步的推广；延期再造术生命质量评分优于即刻再造术,提示应加强术前对即刻再造患者的心理状态评估和教育；术后放疗对乳房外观能产生显著的负面影响；患者对于不同手术方式的满意度相似。
The goal of the study is to investigate the health-related quality of life (HRQL) and patient satisfaction of Chinese breast cancer patients who underwent breast reconstruction, either immediate or delayed, after mastectomy.
Validated Simplified Chinese Edition of SF-36Health Survey was used to evaluate respondents' HRQL and a study specific questionnaire was used to evaluate respondents' satisfaction, including issues on cosmetic outcome and procedure-related aspects.17women with immediate reconstruction (IR),20with delayed reconstruction (DR) and19with mastectomy only were enrolled. Scores of the questionnaire were compared with age and educational level matched healthy women with different occupations.
In all8dimensions of SF-36, no significant difference was found between the mastectomy group, the IR group and the healthy control group; scores of the DR group in4dimensions out of8were significantly higher than the healthy control. The DR group also was superior to the IR group in3dimensions. There is no significant difference between the scores with regard to the satisfaction of the2reconstruction groups. Within every aspect of cosmetic outcome, the score of either reconstruction group was found to be significant higher than that of the mastectomy group, and scores of both IR and DR groups were comparable with that of the healthy control. Postoperative radiotherapy can negatively affect the appearance.
There was no untoward impact that IR and DR had on HRQL. Breast reconstruction could be of advantage to the rehabilitation after mastectomy for breast cancer patients, especially to the improvement of breast appearance. The DR group's scores of SF-36was superior to that of the IR group, indicating assessment of patients' psychological status before surgery was necessary. Radiotherapy had a negative impact on cosmetic outcome. Breast reconstruction using different methods can result in similar patient satisfaction.
引文
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