腔镜与常规开放甲状腺手术对患者生存质量的影响
摘要
背景和目的：近年来腔镜手术应用范围不断扩大，1997年Huscher进行了首例腔镜甲状腺叶切除并获得成功。从此，腔镜甲状腺手术得到了迅速发展。国内近两年来，有数家医院开展了此项手术，我院从2002年开展以来，已成功完成212余例手术，目前是国内开展此手术较多的单位之一。
生存质量作为全面反映患者健康状况的一个指标，可更全面、更客观地评估治疗效果，而腔镜与常规开放甲状腺手术对患者生存质量的影响，目前在国内外作者尚未见此类报道，我们前瞻性地调查和分析59例甲状腺手术患者的生存质量动态变化情况。调查甲状腺手术后患者生存质量的变化情况，比较常规开放手术(OT)和腔镜手术(LT)对患者生存质量影响的差异。
方法：采用修改的消化病生存质量指数(GLQI指数)前瞻性地测定31例腔镜甲状腺手术及28例常规开放甲状腺手术患者在术前以及术后2、4、8、12和16周的生存质量值。生存质量值采用GLQI指数，用(?)±S表示，生存质量指数比较采用Mann-Whitney U检验，由SPSS
10.0软件完成分析统计。
结果：OT组和LT组患者术前平均GLQI指数分别为114.2分和115.9分(P＞0.05)。术后2周OT组和LT组患者GLQI指数分别为107.2分和109.6分，降幅明显(P＜0.05)。术后4周OT组和LT组患者GLQI指数分别为116.8分和118.2分，已超出术前水平(P＞0.05)。手术8周以后，两组GLQI指数明显超出术前水平(P＜0.05)，OT组
硕士学位论文:腔镜与常规开放甲状腺手术对患者生存质量的影响丁雷2004年4月共39页
和LT组GLQI指数在各个测定时点，两组比较无显著差异(P>0.05)。
结论:腔镜与常规开放甲状腺手术对患者生存质量的影响无显著
差异。因美容效果明显，术后近期腔镜组患者心理情绪状态明显高于
传统手术组。
Objective and Bachground:
The indications of laparoscopic surgery is getting more and more widely in modern surgery. Ever since Dr. Huscher successfully finished the 1st laparoscopic thyroidolobectomy in 1997, the laparoscopic thyroidectomy developed quickly all around the world. Several Chinese hospitals have started this operation. Our hospital has successfully launched laparoscopic thyroidectomy in 212 cases ever since we started this practice in 2002, and this has taken us to the leading position in China.
QOL (quality of life) is an index to assess the general health state of a person. Hence it can also be helpful in evaluating the treatment effects in a more objective and more overall aspect. Author has not found report on the influence of laparoscopic and open thyroidectomy to the QOL of patients. In this study we investigated and analyzed the QOL of 59 cases of thyroidectomy prospectively and dynamically. Through the study of the changes with the QOL of patients after thyroidectomy, we hope to compare the difference between the effects on QOL of patients of OT (open thyroidectomy) and LT (laparoscopic thyroidectomy).
Method:
The modified GLQI index was used to test the QOL of 31 cases of LT and 28 cases of OT prospectively. The data was acquired before the operations and 2,4,8,12,16 weeks after the operations respectively. The
value of GLQI was taken as the index of QOL, and it was expressed in the form of X ?5" . The comparison of QOL index was done with Mann-Whitney U test. The statistical process was finished with SPSS10.0 software.
Results:
The average GLQI values of LT group and OT group were 114.2 and 115.9 (P>0.05). The values in OT and LT groups 2 weeks after the operations were 107.2 and 109.6, which indicated significant decrease (P<0.05). The values in OT and LT groups 4 weeks after the operations were 116.8 and 118.2, which exceeded the pre-operative levels (P>0.05). The GLOI values significantly exceeded the pre-operative levels in two groups 8 weeks after the operations (P<0.05). During the whole process, there was no significant difference between the GLOI values of the two groups (P>0.05).
Conclusion:
There was no significant difference between the effects on QOL of OT and LT. However, the LT confirms better cosmetic effects. The psychological state and mood of patients in the laparoscopic group were obviously better than those in the traditional surgery group.
生存质量作为全面反映患者健康状况的一个指标，可更全面、更客观地评估治疗效果，而腔镜与常规开放甲状腺手术对患者生存质量的影响，目前在国内外作者尚未见此类报道，我们前瞻性地调查和分析59例甲状腺手术患者的生存质量动态变化情况。调查甲状腺手术后患者生存质量的变化情况，比较常规开放手术(OT)和腔镜手术(LT)对患者生存质量影响的差异。
方法：采用修改的消化病生存质量指数(GLQI指数)前瞻性地测定31例腔镜甲状腺手术及28例常规开放甲状腺手术患者在术前以及术后2、4、8、12和16周的生存质量值。生存质量值采用GLQI指数，用(?)±S表示，生存质量指数比较采用Mann-Whitney U检验，由SPSS
10.0软件完成分析统计。
结果：OT组和LT组患者术前平均GLQI指数分别为114.2分和115.9分(P＞0.05)。术后2周OT组和LT组患者GLQI指数分别为107.2分和109.6分，降幅明显(P＜0.05)。术后4周OT组和LT组患者GLQI指数分别为116.8分和118.2分，已超出术前水平(P＞0.05)。手术8周以后，两组GLQI指数明显超出术前水平(P＜0.05)，OT组
硕士学位论文:腔镜与常规开放甲状腺手术对患者生存质量的影响丁雷2004年4月共39页
和LT组GLQI指数在各个测定时点，两组比较无显著差异(P>0.05)。
结论:腔镜与常规开放甲状腺手术对患者生存质量的影响无显著
差异。因美容效果明显，术后近期腔镜组患者心理情绪状态明显高于
传统手术组。
Objective and Bachground:
The indications of laparoscopic surgery is getting more and more widely in modern surgery. Ever since Dr. Huscher successfully finished the 1st laparoscopic thyroidolobectomy in 1997, the laparoscopic thyroidectomy developed quickly all around the world. Several Chinese hospitals have started this operation. Our hospital has successfully launched laparoscopic thyroidectomy in 212 cases ever since we started this practice in 2002, and this has taken us to the leading position in China.
QOL (quality of life) is an index to assess the general health state of a person. Hence it can also be helpful in evaluating the treatment effects in a more objective and more overall aspect. Author has not found report on the influence of laparoscopic and open thyroidectomy to the QOL of patients. In this study we investigated and analyzed the QOL of 59 cases of thyroidectomy prospectively and dynamically. Through the study of the changes with the QOL of patients after thyroidectomy, we hope to compare the difference between the effects on QOL of patients of OT (open thyroidectomy) and LT (laparoscopic thyroidectomy).
Method:
The modified GLQI index was used to test the QOL of 31 cases of LT and 28 cases of OT prospectively. The data was acquired before the operations and 2,4,8,12,16 weeks after the operations respectively. The
value of GLQI was taken as the index of QOL, and it was expressed in the form of X ?5" . The comparison of QOL index was done with Mann-Whitney U test. The statistical process was finished with SPSS10.0 software.
Results:
The average GLQI values of LT group and OT group were 114.2 and 115.9 (P>0.05). The values in OT and LT groups 2 weeks after the operations were 107.2 and 109.6, which indicated significant decrease (P<0.05). The values in OT and LT groups 4 weeks after the operations were 116.8 and 118.2, which exceeded the pre-operative levels (P>0.05). The GLOI values significantly exceeded the pre-operative levels in two groups 8 weeks after the operations (P<0.05). During the whole process, there was no significant difference between the GLOI values of the two groups (P>0.05).
Conclusion:
There was no significant difference between the effects on QOL of OT and LT. However, the LT confirms better cosmetic effects. The psychological state and mood of patients in the laparoscopic group were obviously better than those in the traditional surgery group.
引文
1 World Health Organization. The constitution of the World Health Organization WHO Chron, 1947, 1:29.
2 方积乾，陆盈．现代医学统计学．人民卫生出版社，2002，120．
3 WHO.(1993). The development of the WHO quality of life assessment instrument. Geneva,WHO.
4 汤旦林，王松柏．生存质量测定及其在临床试验中的应用．中华医学杂志，1993，74：175—179．
5 Troidl H, Wechsler AS, McKneally ME How to choose a relevant endpoints. In: Troidl H, ed. Surgical research. 3rd ed. New York: Springer, 1997.303—320.
6 Aaronson NK. Quality of life assessment in clinical trials: methodologic Issues. Controlled ClinTrials, 1989, 10:195S.
7 Karnofsky DA, Burchenal JH. Clinical evaluation of chemotherapeutic agents in cancer. In:Mcleod CM, ed. Evaluation of chemotherapeutic agents. New York: Columbia University Press, 1949.
8 Spilker B, White WSA, Simpson RL Jr. Quality of life bibliography and indexes: 1990 update. J Clin Res Pharmacoepidemiol, 1992, 6:87.
9 Spilker B, Simpson RL Jr, Tilson HH. Quality of life bibliography and indexes: 1991 update .J Clin Res Pharmacoepidemiol, 1992, 6:205.
10 王增珍，周有尚．生命质量测定方法及其应用．国外医学社会医
学分册，1990、7：4．
11 Visick AH. A study of the failures after gastrectomy[J]. Ann R Coll Engl, 1948, 3:266—284.
12 Troid H. Quality of life: definition, conceptualization and implication a surgeon's view[J]. Theoretical Surgey,1991, 6:138—142.
13 Troid H, Kusche J, Vestweber KH. Quality of life an important endpoint both in surgical practice and research [J]. Chron Dis, 1987,40(6):523—528.
14 Ware JE. Standards for validating health measures: definition and content [J]. J Chron Dis,1987,40(6):473—480.
15 Asronson NK. Quantitative issues in health-related quality of life assessment [J]. Health Policy,1988,10:217—230.
16 Wood DS. Quality of life assessment recent trends in surgery [J]. Can J Surg,1996,39(5):368—372.
17 Goh P, Tekant Y, Isaac J. The technique of laparoscopic Bill- roth 11 gastrectomy. Surg Laparosc Endosc 1992, 2(3):258—260.
18 Brune IB, Schonleben K. Laparoskopische seit—zu—seit—gastrojejunostomie. Chirurg 1992, 63(7):577—580.
19 Delaitre B, Maignien B. Laparoscopic splenectomy—technical aspects. Surg Endosc 1992, 6:305—308.
20 Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing' s syndrome and pheochromocytoma(Letter). N Engl J Mde 1
992, 327:1033.
21 Berci G, Sackier JM, Paz—Partlow M. Routine or selected intraoperative cholangiography during laparoscopic cholecystectomy? Am J Surg 1991, 161(3):355—360.
22 Jacobs M, Verdeja JC, Goldstein HS. Laparoscopic choledocholithotomy. J Laparoendosc Surg 1991, 1(2):79—82.
23 陈力，戴宁，施小宇，陶思丰，张文瑾．腹腔镜与开腹胆囊切除手术对患者生存质量的影响[J]．中华外科杂志，2002，40(10)：762—765．
24 Hscher CSG, Chiodini S, Napolitano C, Recher A. Endoscopic right thyroid lobectomy. Surg Endosc,1997,11:877.
25 王存川，段立纪，陈钧．腔镜下甲状腺部分切除术．中国内镜杂志，2002．8(7)：19-21．
26 Eypasch E, Wood-Dauphinee S, Williams JI. Der gastrointestinale Lebensqualitaetsindex (GLQI). Der Chirurg,1993;64:264.
27 Eypasch E, Williams JI, Wood-Dauphinee S. Gastrointestinal quality of life index: development,validation and application of a new instrument. Br J Surg, 1995,82:216—222.
28 陈力，戴宁，江献川，陈根富．肝脏手术对患者生存质量的影响．中国实用外科杂志，1997，17：268—271．
29 宋犁君．外科领域的生存质量研究．中国临床康复，2000，4(5)：1296—1297．
30 Troidl H, Kusche J, Vesterweber KH. Pouch versus esophagojejunostomy after total gastrectomy: a randomized clinical trial. World J. Surg, 1987, 11:699—712.
31 Pope CE. The quality of life following antireflux surgery [J]. World J Surg,1992,16:355—358.
32 郭雅，彭民浩，黎乐群．晚期肝癌综合治疗研究进展．临床外科杂志，2002，10(5)：302—304．
33 邵永孚，周志祥．乳腺癌手术治疗术式选择进展．实用肿瘤杂志，1995，10(3)：129—130．
34 张岂凡，赵家宏。胃癌手术治疗的有关进展．中国肿瘤，1997，6(3)：8—9
35 Mccoli P, Berti P, Raffaelli M. Minimally invasive video—assisted thyroidectomy. Am J Surg, 2001, 181:567—570.
36 Yamamoto M, Sasaki A, Asahi H. Endoscopic subtotal thyroidectomy for patients with Grave's disease. Surg Today, 2001, 31:1—4.
37 Yeh TS, Jan YY, Hsu BR. Video—assisted endoscopic thyroidectomy. Am J Surg, 2000, 180:82—85.
38 Bellantone R, Lombardi CP, Raffaelli M. Video—assisted thyroidectomy. J Am Coll Surg, 2002, 194:610—614.
39 王树峰，刘津，黎国屏，王树良．甲状腺手术与颈部美容．河北医药，1997，19(5)：306．
40 朱江帆主编普通外科内镜手术学济南：山东科学技术出版社，
2001,140-151.
41 Ikeda Y, Takami H, Sasaki Y. Endoscopic neck surgery by the axillary approach. J Am Coll Surg, 2000, 191:336—340.
42 王存川，吴东波，陈鉴，胡友主，徐以浩．150例经乳晕入路的腔镜甲状腺切除术临床研究．中国内镜杂志，2003，9(11)：50—52．
43 王晨曦，肖丽玲，王存川．腔镜甲状腺切除术并发症的防治(附169例报告)．中国现代手术学杂志，2003，7(6)：426—427．
2 方积乾，陆盈．现代医学统计学．人民卫生出版社，2002，120．
3 WHO.(1993). The development of the WHO quality of life assessment instrument. Geneva,WHO.
4 汤旦林，王松柏．生存质量测定及其在临床试验中的应用．中华医学杂志，1993，74：175—179．
5 Troidl H, Wechsler AS, McKneally ME How to choose a relevant endpoints. In: Troidl H, ed. Surgical research. 3rd ed. New York: Springer, 1997.303—320.
6 Aaronson NK. Quality of life assessment in clinical trials: methodologic Issues. Controlled ClinTrials, 1989, 10:195S.
7 Karnofsky DA, Burchenal JH. Clinical evaluation of chemotherapeutic agents in cancer. In:Mcleod CM, ed. Evaluation of chemotherapeutic agents. New York: Columbia University Press, 1949.
8 Spilker B, White WSA, Simpson RL Jr. Quality of life bibliography and indexes: 1990 update. J Clin Res Pharmacoepidemiol, 1992, 6:87.
9 Spilker B, Simpson RL Jr, Tilson HH. Quality of life bibliography and indexes: 1991 update .J Clin Res Pharmacoepidemiol, 1992, 6:205.
10 王增珍，周有尚．生命质量测定方法及其应用．国外医学社会医
学分册，1990、7：4．
11 Visick AH. A study of the failures after gastrectomy[J]. Ann R Coll Engl, 1948, 3:266—284.
12 Troid H. Quality of life: definition, conceptualization and implication a surgeon's view[J]. Theoretical Surgey,1991, 6:138—142.
13 Troid H, Kusche J, Vestweber KH. Quality of life an important endpoint both in surgical practice and research [J]. Chron Dis, 1987,40(6):523—528.
14 Ware JE. Standards for validating health measures: definition and content [J]. J Chron Dis,1987,40(6):473—480.
15 Asronson NK. Quantitative issues in health-related quality of life assessment [J]. Health Policy,1988,10:217—230.
16 Wood DS. Quality of life assessment recent trends in surgery [J]. Can J Surg,1996,39(5):368—372.
17 Goh P, Tekant Y, Isaac J. The technique of laparoscopic Bill- roth 11 gastrectomy. Surg Laparosc Endosc 1992, 2(3):258—260.
18 Brune IB, Schonleben K. Laparoskopische seit—zu—seit—gastrojejunostomie. Chirurg 1992, 63(7):577—580.
19 Delaitre B, Maignien B. Laparoscopic splenectomy—technical aspects. Surg Endosc 1992, 6:305—308.
20 Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing' s syndrome and pheochromocytoma(Letter). N Engl J Mde 1
992, 327:1033.
21 Berci G, Sackier JM, Paz—Partlow M. Routine or selected intraoperative cholangiography during laparoscopic cholecystectomy? Am J Surg 1991, 161(3):355—360.
22 Jacobs M, Verdeja JC, Goldstein HS. Laparoscopic choledocholithotomy. J Laparoendosc Surg 1991, 1(2):79—82.
23 陈力，戴宁，施小宇，陶思丰，张文瑾．腹腔镜与开腹胆囊切除手术对患者生存质量的影响[J]．中华外科杂志，2002，40(10)：762—765．
24 Hscher CSG, Chiodini S, Napolitano C, Recher A. Endoscopic right thyroid lobectomy. Surg Endosc,1997,11:877.
25 王存川，段立纪，陈钧．腔镜下甲状腺部分切除术．中国内镜杂志，2002．8(7)：19-21．
26 Eypasch E, Wood-Dauphinee S, Williams JI. Der gastrointestinale Lebensqualitaetsindex (GLQI). Der Chirurg,1993;64:264.
27 Eypasch E, Williams JI, Wood-Dauphinee S. Gastrointestinal quality of life index: development,validation and application of a new instrument. Br J Surg, 1995,82:216—222.
28 陈力，戴宁，江献川，陈根富．肝脏手术对患者生存质量的影响．中国实用外科杂志，1997，17：268—271．
29 宋犁君．外科领域的生存质量研究．中国临床康复，2000，4(5)：1296—1297．
30 Troidl H, Kusche J, Vesterweber KH. Pouch versus esophagojejunostomy after total gastrectomy: a randomized clinical trial. World J. Surg, 1987, 11:699—712.
31 Pope CE. The quality of life following antireflux surgery [J]. World J Surg,1992,16:355—358.
32 郭雅，彭民浩，黎乐群．晚期肝癌综合治疗研究进展．临床外科杂志，2002，10(5)：302—304．
33 邵永孚，周志祥．乳腺癌手术治疗术式选择进展．实用肿瘤杂志，1995，10(3)：129—130．
34 张岂凡，赵家宏。胃癌手术治疗的有关进展．中国肿瘤，1997，6(3)：8—9
35 Mccoli P, Berti P, Raffaelli M. Minimally invasive video—assisted thyroidectomy. Am J Surg, 2001, 181:567—570.
36 Yamamoto M, Sasaki A, Asahi H. Endoscopic subtotal thyroidectomy for patients with Grave's disease. Surg Today, 2001, 31:1—4.
37 Yeh TS, Jan YY, Hsu BR. Video—assisted endoscopic thyroidectomy. Am J Surg, 2000, 180:82—85.
38 Bellantone R, Lombardi CP, Raffaelli M. Video—assisted thyroidectomy. J Am Coll Surg, 2002, 194:610—614.
39 王树峰，刘津，黎国屏，王树良．甲状腺手术与颈部美容．河北医药，1997，19(5)：306．
40 朱江帆主编普通外科内镜手术学济南：山东科学技术出版社，
2001,140-151.
41 Ikeda Y, Takami H, Sasaki Y. Endoscopic neck surgery by the axillary approach. J Am Coll Surg, 2000, 191:336—340.
42 王存川，吴东波，陈鉴，胡友主，徐以浩．150例经乳晕入路的腔镜甲状腺切除术临床研究．中国内镜杂志，2003，9(11)：50—52．
43 王晨曦，肖丽玲，王存川．腔镜甲状腺切除术并发症的防治(附169例报告)．中国现代手术学杂志，2003，7(6)：426—427．
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