不同治疗方式甲状腺微小乳头状癌患者生活质量的比较  

Comparison of Quality of Life of Patients with Papillary Thyroid Microcarcinoma Treated by Different Modalities

作　　者：兰雨 张明博 张艳 宋青 阎琳 肖静 罗渝昆 LAN Yu;ZHANG Mingbo;ZHANG Yan;SONG Qing;YAN Lin;XIAO Jing;LUO Yukun(Department of Ultrasound,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;Department of Imaging and Nuclear Medicine,School of Medicine,Nankai University,Tianjin 300071,China)

机构地区：[1]中国人民解放军总医院第一医学中心超声诊断科,北京100853 [2]南开大学医学院影像医学与核医学专业,天津300071

出　　处：《中国医学科学院学报》2021年第3期328-337,共10页Acta Academiae Medicinae Sinicae

基　　金：国家自然科学基金(81901746);北京市首都特色专项课题(Z181100001718017)。

摘　　要：目的比较不同治疗方式下甲状腺微小乳头状癌(PTMC)患者生活质量的差异。方法以2019年10月至12月在中国人民解放军总医院第一医学中心超声诊断科接受随访的149例PTMC治疗后患者为研究对象,根据手术方式将其分为超声引导下射频消融治疗(RFA)组(n=80)、甲状腺腺叶切除(HT)组(n=34)及甲状腺全切除(TT)组(n=35)。所有患者均完成以下3个量表:36条目简明健康量表(SF-36)、甲状腺癌特异性健康相关生活质量量表(THYCA-QoL)及恐惧疾病进展简化量表(FoP-Q-SF),采用多重线性回归分析调整混杂因素,比较3种治疗方式下患者生活质量评分的差异。结果SF-36量表中,RFA组及HT组患者的躯体健康(PCS)(P=0.006,P=0.033)及生理职能(RP)(P=0.003,P=0.001)均显著高于TT组,但RFA组与HT组之间在PCS(P=1.000)及RP(P=1.000)方面差异无统计学意义;RFA组患者精神健康(MCS)评分明显高于TT组患者(P=0.034)。THYCA-QoL量表中,TT组患者的瘢痕问题评分显著高于HT组(P=0.003)及RFA组(P<0.001),RFA组患者体质量增加的抱怨显著低于HT组(P=0.028)及TT组(P<0.001)。FoP-Q-SF量表中,3组患者对疾病进展担忧的评分差异无统计学意义(P>0.05)。结论与传统开放手术相比,超声引导下RFA在提高患者生活质量方面具有独特优势,可作为PTMC开放手术治疗的替代选择。Objective To compare the health-related quality of life(HRQoL)of patients with papillary thyroid microcarcinoma(PTMC)treated by different modalities.Methods The PTMC patients after treatment who came to our department for follow-up from October to December in 2019 were enrolled and assigned into three groups according to treatment modalities:radiofrequency ablation(RFA)group(n=80),hemithyroidectomy(HT)group(n=34),and total thyroidectomy(TT)group(n=35).All patients completed three scales:short form 36-item health survey(SF-36),thyroid cancer-specific health-related quality of life questionnaire(THYCA-QoL),and fear of progression questionnaire-short form(FoP-Q-SF).Multivariate linear regression analysis was employed to adjust for confounders and the quality of life scores were compared among the three treatment modalities.Results In the SF-36,physical component summary(PCS)(P=0.006,P=0.033)and role-physical(RP)(P=0.003,P=0.001)scores of patients in the RFA and HT groups were significantly higher than those in the TT group,whereas PCS(P=1.000)and RP(P=1.000)showed no significant difference between the RFA group and the HT group.In addition,the mental component summary(MCS)score in RFA group was higher than that in TT group(P=0.034).The THYCA-QoL demonstrated that the patients in TT group complained more about scar than the patients in HT(P=0.003)and RFA(P<0.001)groups,and the patients in the RFA group complained less about weight gain than those in the HT(P=0.028)and TT(P<0.001)groups.In the FoP-Q-SF,the scores of the quality of life of patients concerned about disease progression had no significant difference among the three groups(P>0.05).Conclusion Compared with traditional open surgery,ultrasound-guided RFA has unique advantages in improving patients’quality of life and can be used as an alternative to open surgery for PTMC.

关 键 词：甲状腺癌 生活质量 射频消融 甲状腺腺叶切除术 甲状腺全切除术 

分 类 号：R736.1[医药卫生—肿瘤]