摘要
目的:比较各种因素对喉癌患者术后生存质量的影响。方法:回顾性分析行手术治疗的303例喉癌患者,采用中文版(EORTC)QLQ-C30(V3.0)及QLQ-H&N35生存质量问卷进行评估,比较各因素与喉癌术后患者生存质量的关系。结果:303例患者中目前仍保留气管造瘘者78例(其中全喉切除59例,部分喉切除19例);4例仍带鼻饲管。女性患者在躯体功能、总健康状况等方面不如男性(P<0.05)。高龄患者较低龄患者躯体功能及语言能力差(P<0.05)。声门型患者总健康状况最好,而吞咽问题方面声门上型最差。临床晚期(Ⅲ、Ⅳ期)患者在多个领域得分不如临床早期(Ⅰ、Ⅱ期)患者,Ⅲ期患者比Ⅳ期患者吞咽问题更明显。微创手术及喉裂开声带切除术比部分及全喉切除者生存质量好。部分喉切除者在躯体功能、情绪功能、总健康状况、感觉、语言、咳嗽、病态感、进食管等领域比全喉切除者好,但在疲倦、疼痛、气促、吞咽、口干、唾液黏稠领域不如后者;而水平部分喉切除者吞咽问题明显。术式是影响语言功能的独立因素。手术同期行颈廓清者比未做颈廓清者有更多的不适症状。有气管造瘘者在生存质量的多个领域明显差于无气管造瘘者,且是语言功能和总健康状况领域的独立影响因素。结论:各临床特征影响不同的生存质量领域。术式是影响语言功能的独立因素。是否有气管造瘘是影响总健康状况的重要因素。
Objective：To explore and compare the effect of clinical characters on quality of life（QOL） of laryngeal carcinoma postoperative patients.Method：We performed a retrospective cohort follow up study of 303 patients who underwent operation for laryngeal carcinoma.The Chinese version of the general and the head and neck specific quality of life questionnaires of the European Organization for the Research and Treatment of Cancer（EORTC QLQ-C30 and EORTC QLQ-HH35） were used to measure the quality of life of those patients in the cohort,to study the relationship between QOL and clinical factors.Result：In the 303 cases,there were 78 cases retaining the permanent tracheostomas（59 total laryngectomy and 19 partial laryngectomy）;4 patient retain the nosal feed pipe.Female patients were worse than male patients in the domain of physical funtion and global QOL（P0.05）.Older patients were worse than younger patients in the domain of physical funtion and speech（P0.05）.Patients with glottic tumors experience better global QOL than their peers with underglottic or supreglottic tumors.The patients with supreglottic tumor have more problem with swallowings（P0.05）.Earlier stage patients have better suitation in many domains than later stage patients,but Ⅲ stage have more difficulty with swallowing than Ⅳ stage.Patients who accepted minimally invasive operation and laryngofissure have better QOL than those accepted partial laryngectomy or total laryngectomy;total laryngectomee have more problems with physical,emotion function,global QOL,sense,speech,cough and morbid feeling than patients with partial laryngectomy,but less problem with fatigue,pain,dyspnea,swollowing and dry mouth;Patients with partial horizontal laryngectomy have more difficulty with swallowing.In the multivaribals analysis,the operation mode was an independent factor to speech problem.Patients who accepted neck dissction have more negative outcomes than patients without neck dissection.In the univarible analysis,the permanent tracheostomy was a notable factor which affected many domains in the quality of life;multivaribles analysis showed that permanent tracheostomy was an important factor which worked on global quality of life.Conclusion ： The quality of life was affected by many clinical factors.The operation mode was an independent factor which affect speech problem.Decannulation after partial laryngctomy was very important to keep the quality of life.
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
北大核心
2013年第4期169-174,共6页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
