术后重建修复对口腔肿瘤切除患者生活质量影响研究  

Influence of repair and functional reconstruction after tumorrectomy on quality of life for patients with oral tumor

作　　者：鲍光辉[1] 刘静[1] 裴赛敏[1] 张俊卿[1] 

机构地区：[1]常德市第一人民医院口腔科,湖南常德415003

出　　处：《中国现代医学杂志》2015年第3期66-70,共5页China Journal of Modern Medicine

摘　　要：目的探讨术后重建修复对口腔肿瘤切除患者生活质量的影响。方法本研究设计使用两种不同问卷,调查术前和术后3、6及12个月内患者生活质量的变化情况:华盛顿大学生活质量和头部、颈部的性能状态量表。2010年1月-2012年12月92例因口腔癌在本院接受损伤修复术的患者均被纳入本次研究,但只有35例(38%)无病生存患者进行最后评估。采用华盛顿大学生活质量(缺陷,咀嚼,吞咽,言语理解)量表对35例患者术前及术后(3、6和12个月)生活质量进行评价。采用秩和的非参数检验和Logistic回归多因素分析影响生活质量的因素。并比较术前术后华盛顿大学生活质量和头部和颈部的性能状态量表评分差异。结果术后3个月生活质量评分明显下降,6个月和12个月后逐渐改善。大多数患者(77%)在术后12个月保持正常或接近正常的功能。患者咀嚼功能明显恶化(P<0.05),接受下颌骨阶段性切除术的患者预后更差(P<0.05)。多因素分析表明,咀嚼功能与下颌骨切除术相关(P=0.038)。此外,修复类型是影响华盛顿大学生活质量总分的独立因素(P=0.038),游离皮瓣修复患者预后更好。尽管晚期口腔癌患者预后极差,但修复技术对维持生活质量满意度有重要作用。结论术后口腔修复重建对改善口腔肿瘤切除患者术后生活质量有重要意义。【Objective】To investigate the influence of repair and functional reconstruction after tumorrectomy on quality of life for patients with oral tumor.【Methods】A prospective evaluation of pre- and post-operative quality of life was made at 3, 6 and 12 months to assess variations during follow-up using two different questionnaires： the University of Washington Quality of Life and the Head and Neck Performance Status Scale. Between Jan 2010 and Dec 2012, 92 patients with oral cancer requiring reconstruction were treated. All were included in the study, but only 35（38%） finished the final evaluation protocol at one year after surgery without evidence of disease. The mean pre- and post-operative（3, 6 and 12 months） scores of the questionnaires and the scores of specific University of Washington Quality of Life categories（disfigurement, chewing, swallowing, comprehension of speech） were evaluated.The impact of different factors on the residual quality of life such as gender, extension of tongue and mandibular defects, type of reconstruction, and radiotherapy was statistically quantified with a Wilcoxon non-parametric test and logistic regression for multivariate analysis. 【Results】Comparison of mean pre- and post-operative scores between the University of Washington Quality of Life and the Head and Neck Performance Status Scale, showed a similar trend during the study period with a significant decrease at 3 months after surgery and subsequent gradual improvement at 6 and 12 months. The majority of patients（77%） preserved normal or near normal functions at 12 months after surgery. The chewing domain worsened considerably（P〈0.05）, with poorer outcome in patients undergoing segmental mandibulectomy（P〈0.05）. By multivariate analysis, mandibular resection maintained its statistical significance in the chewing domain（P =0.038）. Moreover, the type of reconstruction was an independent factor（P =0.038）that influenced the total score of the University of Washington Quality of Life,

关 键 词：口腔癌 重建手术 生活质量 

分 类 号：R739[医药卫生—肿瘤]