食管癌术后症状的混合方法研究

Postoperative symptoms of esophageal cancer:mixed methods research

目的:应用混合方法研究食管癌病人术后常见症状及影响因素。方法 :应用定性及定量相结合的混合方法。半结构式访谈调查20例食管癌术后病人的症状。以症状体验模型为理论框架形成调查表,采用目的性抽样选取114例食管癌术后病人,调查症状的发生频率、强度以及对生活的困扰程度。结果:定量研究中,口干、咳痰、咳嗽等11个症状的发生率超过50%。频繁程度高发组症状前5位的是口干、乏力、咳嗽、消瘦、咳痰;症状重度组前5位的是口干、咳痰困难、咳嗽、乏力、咳痰;困扰严重组前5位的是口干、咳痰困难、咳嗽、咳痰、乏力。病理类型为小细胞癌的病人咳嗽发生率高。在声音嘶哑和失眠的严重程度以及声音嘶哑困扰度方面,达芬奇机器人手术明显优于胸腔镜手术(P<0.05)。食管中段肿瘤有较高的咳嗽频繁程度和乏力频繁程度,咳痰的严重程度也较高(P<0.05)。定性研究得出多症状广泛存在和症状表达不全。结论:食管癌病人术后经历多种症状的困扰,精细手术可使部分症状严重程度降低。

objective Mixed methods research was used to analyze the common symptoms of patients with esophageal cancer postoperatively and some associated factors.Methods A mixed method study was done utilizing qualitative and quantitative data.Semi-structured interview for symptoms was performed with 20 patients with esophageal cancer after operation.The symptoms experience model was used as theoretical framework for questionnaire and 114 cases with esophageal cancer after operation were selected for survey of symptoms frequency and intensity and harassment.Results The quantitative study showed the incidence of all 11 symptom was more than 50% including thirsty,phlegm and cough.The 5 symptoms arranged thirsty,fatigue,cough,angular and phlegm according to frequency.The 5 symptoms arranged thirsty,difficult sputum,cough,fatigue and phlegm according to severity,and thirsty,difficult sputum,cough,phlegm and fatigue according to harassment.Cough had higher incidence in the patients with small cell lung cancer based on pathological examination.Da Vinci surgical procedure was superior to the thoracoscope surgery with hoarse and insomnia less severe and hoarse less harassment（P 〈0.05）.The patients with middle esophageal cancer had cough and fatigue of more frequency and phlegm more severe（P 〈0.05）.Qualitative study showed the patients had several symptoms and complaint unclear.Conclusions The esophageal cancer patients experienced a variety of symptoms after surgery.Precise surgery can reduce some symptom severity.