热敏灸干预对腹腔镜肝癌切除术后胃肠功能恢复的影响

目的:观察热敏灸干预对腹腔镜肝癌切除术后患者胃肠功能恢复的影响。方法:选取行腹腔镜肝癌切除术的原发性肝癌患者74例,按随机数字表法分为试验组和对照组各37例。对照组采用围手术期常规护理,试验组在对照组的基础上加用热敏灸干预。比较2组术后首次肛门排气和排便时间、术后肝胆肿瘤治疗功能评定量表(FACT-Hep)评分、术后不良反应发生情况、术后胃肠功能康复疗效和住院时间。结果:试验组总有效率为94.60%,对照组为83.78%,试验组总有效率高于对照组,但差异无统计学意义(P>0.05)。试验组术后首次肛门排气时间、排便时间均短于对照组,差异均有统计学意义(P<0.05)。术后,试验组平均FACT-Hep量表评分为(129.65±3.36)分,对照组为(113.68±4.65)分,2组比较,差异有统计学意义(P<0.05)。试验组发生腹痛、腹胀、恶心呕吐发生率分别为13.51%、18.92%、8.11%,对照组分别为35.14%、48.65%、27.03%,2组比较,差异均有统计学意义(P<0.05)。经秩和检验,试验组平均住院时间短于对照组,差异有统计学意义(P<0.05)。结论:热敏灸疗法能促进腹腔镜肝癌切除患者术后肛门排气排便,提高术后生活质量,促进术后胃肠功能恢复,缩短住院时间,且不良反应发生率相对较低。

两种心理社会适应量表在化疗期乳腺癌患者中的应用比较

目的比较两种心理社会适应量表在化疗期乳腺癌患者中的应用效果。方法选取化疗期乳腺癌患者743例为研究对象,分别采用疾病心理社会适应问卷(PAIS-SR)、乳腺癌患者心理社会适应问卷测量患者的心理社会适应状况,以乳腺癌患者生存质量量表(FACT-B)为效标,比较两种心理社会适应量表的相关性及效度。结果化疗期乳腺癌患者PAIS-SR得分46.77±15.89,乳腺癌患者心理社会适应问卷得分169.65±25.52,FACT-B量表得分97.47±17.92;PAIS-SR总分及各维度与心理社会适应问卷总分具有显著相关性(r值为-0.245^-0.668,均P<0.01);乳腺癌患者心理社会适应问卷总分、PAIS-SR总分与FACT-B得分的相关系数分别为0.730、-0.780(均P<0.01)。结论两种问卷所测患者心理社会适应度均处于中等水平,两种问卷的相关性及与效标量表的相关性较强,均可用于化疗期乳腺癌患者的心理社会适应状况的测量。PAIS-SR量表测量的维度更全面,心理社会适应问卷更偏重于患者心理状况的测量,临床应用中可根据实际需要选择合适的量表。

Health-related quality of life evaluated by tumor node metastasis staging system in patients with hepatocellular carcinoma

AIM: To investigate and evaluate the change in healthrelated quality of life (HRQoL) by tumor node metastasis (TNM) staging system in patients with hepatocellular carcinoma (HCC). METHODS: A total of 140 patients diagnosed with HCC between June 2008 and April 2009 in our department were enrolled to this study. One hundred and thirty-five (96.5%) patients had liver cirrhosis secondary to hepatitis B virus (HBV) infection, 73 (54.07%) of them being HBV DNA positive; the other etiologies of liver cirrhosis were alcoholic liver disease (1.4%), hepatitis C (1.4%) or cryptogenic (0.7%). All subjects were fully aware of their diagnosis and provided informed consent. HRQoL was assessed before treatment using the functional assessment of cancer therapy-hepatobiliary (FACT-Hep) questionnaire. Descriptive statistics were used to evaluate demographics and disease-specific characteristics of the patients. One-way analysis of variance and independent samples t tests were used to compare the overall FACT-Hep scores and clinically distinct TNM stages. Scores for all FACT-Hep items were analyzed by frequency analyses. The mean scores obtained from the FACT-Hep in different Child-Pugh classes were also evaluated. RESULTS: The mean FACT-Hep scores were reduced significantly from TNM StageⅠto Stage Ⅱ, Stage ⅢA, Stage ⅢB group (687 ± 39.69 vs 547 ± 42.57 vs 387 ± 51.24 vs 177 ± 71.44, P = 0.001). Regarding the physical and emotional well-being subscales, scores decreased gradually from Stage Ⅰ to Stage ⅢB (P = 0.002 vs Stage Ⅰ; P = 0.032 vs Stage Ⅱ; P = 0.033 vs Stage ⅢA). Mean FACT-Hep scores varied by Child-Pugh class, especially in the subscales of physical well-being, functional well-being and the hepatobiliary cancer (P = 0.001 vs Stage I; P = 0.036 vs Stage Ⅱ; P = 0.032 vs Stage ⅢA). For the social and family well-being subscale, only Stage ⅢB scores were significantly lower as compared with Stage Ⅰ scores (P = 0.035). For the subscales of functional well-being and hepatobiliary cancer, there were significant differences for Stages ⅡΙ, ⅢA and ⅢB (P = 0.002vs StageⅠ). CONCLUSION: HRQoL of patients with HCC worsens gradually with progression of TNM stages. The most impaired subscales of HRQoL, as measured by FACT-Hep, were physical and emotional well-being.

Health-related quality of life in patients that have undergone liver resection:A systematic review and meta-analysis

BACKGROUND Mortality after hepatectomy has decreased,and the quality of various surgical approaches to hepatectomy have been evaluated.Various assessments of quality of life(QOL)after hepatectomy have been developed and investigated in different clinical settings.AIM To conduct a systematic review and meta-analysis to examine two clinical topics:Laparoscopic hepatectomy vs open hepatectomy,and preoperative QOL status vs postoperative QOL status.METHODS A systematic literature search was performed using PubMed and MEDLINE,including the Cochrane Library Central.The following inclusion criteria were set for inclusion in this meta-analysis:(1)Studies comparing preoperative QOL and postoperative QOL;and(2)Studies comparing QOL between laparoscopic hepatectomy and open hepatectomy.RESULTS A total of 8 articles were included in this meta-analysis.QOL was better after laparoscopic hepatectomy than after open hepatectomy.CONCLUSION The outcomes of evaluations of QOL after hepatectomy can depend on the type of questionnaire used,the timing of the assessment,and the etiology of the hepatic disease.

Quality of life outcomes including neuropathy-associated scale from a phase II,multicenter,randomized trial of eribulin plus gemcitabine versus paclitaxel plus gemcitabine as first-line chemotherapy for HER2-negative metastatic breast cancer:Korean Cancer Study Group Trial(KCSG BR13-11)

Background: A phase II clinical trial of the comparison between eribulin plus gemcitabine (EG) and paclitaxel plus gemcitabine (PG) as first-line chemotherapy for patients with metastatic breast cancer (MBC) found that the EG regimen was less neurotoxic, but was similar in efficacy to the PG regimen. In the present study, we analyzed functional assessment of cancer therapy-taxane (FACT-Taxane) questionnaires from patients in this clinical trial to determine their quality of life (QoL). Methods: QoL was assessed using the Korean version of the FACT-Taxane questionnaires. After baseline assessment, QoL was assessed every 2 cycles for 12 cycles and every 3 cycles thereafter. The linear mixed model was used to evaluate the difference in QoL between the EG and PG arms. Results: Of the 118 enrolled patients, 117 responded to the FACT-Taxane questionnaires at baseline, 1 in the PG arm did not. Baseline QoL scores were not different between the EG and PG arms. During treatment, taxane subscale scores were significantly higher in the PG arm than in the EG arm after 2-13 cycles of chemotherapy (all P < 0.05), except for the 11th cycle. Neuropathy-specific analysis showed that patients in the PG arm had earlier and more severe neuropathic symptoms than those in the EG arm (P < 0.001). Conclusions: In our QoL analysis, the EG regimen delayed and decreased neuropathy as compared with the PG regimen. Therefore, eribulin would be a reasonable substitute for paclitaxel as first-line chemotherapy for MBC.