不同手术方式对于气胸术后长期生活质量的前瞻性研究

A Prospective Study of Long-term Quality of Life After Different Surgical Methods for Pneumothorax

目的:探讨原发性或继发性气胸治疗的两种手术方式:电视胸腔镜手术(Video-Assisted Thoracoscopic Surgery,VATS)、后外侧开胸手术(posterolateral thoracotomy,PT)术后长期生活质量(QOL)状况。方法:采用患者生活质量测定量表核心量表(EORTCQLQ-C 3 0,简称QL Q-C3 0)中文版调查从2008年12月至2009年12月在我科治疗的60例原发性或继发性气胸患者,对其术前和术后1,3,6和12个月的QL Q-C30得分与参考值进行比较。结果:①术前术后生活质量相比较,功能方面,VATS组无明显差异,而后外侧开胸组患者术后6月躯体功能降低,12月情绪功能升高;1,3,12个月总体状况显著升高,有统计学差异;症状方面,VATS组,术后1月呼吸困难症状加重;术后1,3,6个月经济困难加重,有统计学差异;后外侧开胸组,术后1,3个月疼痛加重;术后6月疲乏减轻;术后12月,呼吸困难减轻;②两组术后生活质量相比较,功能方面,后外侧开胸组,术后6月躯体功能降低,术后12月情绪功能升高,术后1,3,12个月总体状况得分升高;症状方面,VATS组,呼吸困难术后1月升高,术后12月降低;后外侧开胸手术组,术后1,3个月疼痛降低;术后6月疲乏降低;术后1,3,6个月经济困难降低。结论:术后生活质量与术前比较,不同的手术方式会产不同的效果,总体来说手术是改善气胸患者生活质量的重要方法。比较两种方法术后生活质量,VATS组较后外侧开胸组患者功能恢复较快,而症状相关项目则具有各自的优缺点。

Objective： To investigate the long-term quality of life（QOL） in the treatment of primary or secondary pneumothorax,two surgical methods,video-assisted thoracic surgery（Video-Assisted Thoracoscopic Surgery,VATS） and posterolateral thoracotomy（posterolateral thoracotomy,PT）,were assessed in this prospective study.Methods： The quality of life questionnaire,EORTC QLQ-C30 Chinese version,was used to assess the patient＇s quality of life.All the 60 patients from December 2008 to December 2009 in our department treated for primary or secondary pneumothorax were collected in this study.The QLQ-C30 scores of preoperative and postoperative 3,6 and 12 months were compared each other.Results： First,there was no significant difference in the function of preoperative and postoperative quality of life.In the lateral thoracotomy group,patients with lower physical function 6 months after surgery,and in the 12 months postoperative emotional function increased.It was significantly increased in the 1,3,12 months.In the symptoms of VATS group,dyspnea was increased at one month after surgery,and economic hardship rose at 1,3,6 months after surgery.In posterolateral thoracotomy group,pain was increased at 1,3 months after surgery.Fatiguea was reduced at 6 months after surgery,and dyspnea was increased at 12 month after surgery.In the posterolateral thoracotomy group,physical function was decrease at 6 months after surgery,and emotional function increased at 12 months after surgery.Second,compared with the VATS group,the patient＇s postoperative quality of life was lower physical function 6 months after surgery in lateral thoracotomy group.On the contrary,the 12 months after surgery emotional function was increased in lateral thoracotomy group.The overall condition score was increased in 1,3,12 months postoperative.Dyspnea increased 1 month after surgery,and decreased 12 months after surgery in VATS group compared with posterolateral thoracotomy group.In posterolateral thoracotomy group,the pain was decreased 1,3 months after surgery,and fatigue was reduced 6 months preoperative.Economic hardship was reduced also 1,3,6 months after sugery.Conclusion： Compare the preoperative and postoperative quality of life,we found that surgery can improve the quality of life in patients with pneumothorax.Compare the two methods of postoperative quality of life,the functional recovery of VATS group was faster than the PT groups,and symptoms have its own advantages and disadvantages.