口腔癌患者术后生存质量评价及影响因素分析

Evaluation of quality of life in oral cancer patients postoperatively and analysis of influencial factors

目的:评价口腔癌患者术后的生存质量(quality of life,QOL),并探讨影响无瘤生存者术后QOL的可能因素。方法:采用SF-36及UW-QOL测量55例口腔癌患者术前和术后12个月的QOL,采用SPSS12.0软件包对数据进行统计学分析。结果:①复发患者术后的QOL显著低于无瘤生存者。②与术前相比,术后12个月时,无瘤生存者仍存在较严重的治疗相关的特异性问题和较差的社会功能状况。③文化程度、婚姻状况、共病、缺损范围及放疗影响无瘤生存者术后QOL,初、高级文化程度、配偶健在、不伴有共病、缺损最大径<6cm及术后未放疗的患者,术后QOL较高。④不同的颈清扫术式对无瘤生存者手术前后QOL总分的差值没有影响,但副神经保留组术后的肩功能明显优于副神经切除组。结论:保留副神经可改善颈清扫患者的肩功能;降低复发率、加强慢性病的预防及控制、改进放疗手段、增加社会支持及必要的康复指导和治疗可提高口腔癌患者术后的QOL。

PURPOSE： To evaluate the postoperative quality of life（QOL） of patients with oral cancer and to explore possible factors impacting the QOL of 1-year disease-free survivors.METHODS： The QOL of 55 consecutive patients was assessed preoperatively and 12 months after surgery by two questionnaires： SF-36 and UW-QOL.All data were analyzed by SPSS12.0 software package.RESULTS： ①The postoperative QOL of patients with recurrence was significantly lower than that of patients without recurrence.②The scores of some disease-specific problems and social functioning could not approach the pretreatment level at 12-month for disease-free survivors.③The factors influencing QOL of disease-free survivors 12 months postoperatively included the level of education,marital status,comorbidity,the extent of defect,and radiotherapy.Patients with primary/high education,or with the maximal diameter of defect〈6cm,or with spouse,or without comorbidity,or without radiotherapy postoperatively showed better QOL 12 months after operation.④There was no difference of composite scores among various forms of neck dissection.However,the scores of shoulder of patients with preservation of accessory nerve were higher than that of patients with resection of accessory nerve.CONCLUSION： Preservation of accessory nerve for patients undergoing neck dissection could enhance their shoulder function.Diminishing recurrence rate,reinforcing the prevention and control of chronic diseases,improving radiotherapy,strengthening social supports and providing necessary instructions for rehabilitation could improve postoperative QOL of patients with oral cancer.