106例甲状腺乳头状癌患者行甲状腺全切手术后生存质量分析

Analysis of life quality in 106 papillary thyroid carcinoma patients undergoing total thyroidectomy

目的探讨甲状腺乳头状癌患者行甲状腺全切除手术前后生存质量的变化趋势及影响因素。方法选取2016年6月至2019年5月入住耳鼻咽喉头颈外科的甲状腺乳头状癌行甲状腺全切除手术患者106例,其中女77例(72.64%),男29例(27.36%),17~68岁,平均(40±13.2)岁。按患者性别、年龄、文化程度、家庭经济状况、有无行颈部淋巴结清扫术以及术后是否行131I治疗等影响因素进行分组,使用头颈部肿瘤生存质量评估量表,联合Zung氏焦虑及抑郁自评量表对患者术前和术后1、3、6个月的生存质量及心理状况进行评估,使用重复测量方差分析比较其差异。结果甲状腺乳头状癌患者行甲状腺全切手术后的生存质量评分在术后1个月下降最明显,差异有统计学意义(P<0.05),术后3个月开始逐渐上升,但仍有明显差异(P<0.05),至术后6个月回归术前水平(P>0.05)。对于影响患者生存质量的客观因素分析提示,文化程度、术后131I治疗及家庭经济情况差异无统计学意义(P>0.05),而患者年龄、性别和颈部淋巴结清扫术对于甲状腺乳头状癌患者术后生存质量造成的影响均差异有统计学意义(P<0.05)。术前术后Zung氏焦虑及抑郁自评量表分值差异无统计学意义(P>0.05)。结论对于年轻女性行颈部淋巴结清扫术的甲状腺乳头状癌患者,临床医生应术前加强沟通、术中选择小切口、术后鼓励患者锻炼以及调控好血钙和甲状腺激素水平,提高生存质量。

Objective To investigate the changes of quality of life before and after total thyroidectomy in patients with papillary thyroid carcinoma and its influencing factors. Methods A total of 106 patients with papillary thyroid carcinoma who underwent total thyroidectomy in our hospital during June 2016 and May 2019, including 77 female(72.64%) and 29 male(27.36%), age 17 to 68 years, average 40 years. They were divided into groups according to gender, age, educational level, family financial status, whether patients received neck lymph node dissection and 131I treatment. Patients? quality of life and psychological status before, 1 month, 3 months and 6 months after total thyroidectomy were assessed with quality of life assessment scale for patients with head and neck tumors, Zung?s self-rating anxiety scale, and Zung?s self-rating depression scale. Results Patients? quality of life was drastically decreased 1 month after surgery(P<0.05), began to gradually increase 3 months after surgery(P<0.05), and returned to the preoperative level 6 months after surgery(P>0.05). Patients? education level, 131I treatment and family financial status did not affect the quality of life(P>0.05), while age, gender and neck lymph node dissection had significant impact on patients? quality of life(P<0.05). There was no significant difference in scores of Zung?s self-rating anxiety scale and Zung?s self-rating depression scale before and after surgery(P>0.05). Conclusion For young female patients with papillary thyroid carcinoma who underwent neck lymph node dissection, good communication before operation, small incision during operation, and sufficient exercise after operation to control blood calcium and thyroid hormone levels are important to improve the quality of life.