- 學位論文
評估攝護腺癌病患接受達文西機械手臂輔助根除性攝護腺切除術之生活品質
To evaluate the Quality of Life for patients with prostate cancer receiving da Vinci Robotic Radical Prostatectomy
摘要
根據民國96年衛生署癌症登記資料顯示，癌症是國人十大死因首位，其中男性癌症中的攝護腺癌的發生率由民國84年的第七位躍升至第五位。由於平均壽命的延長、生活環境致癌因素及飲食逐漸西化的影響，預估攝護腺癌的發生率會逐漸增加。攝護腺癌的治療方式有:手術治療、放射線治療及荷爾蒙治療，由全民健保局申報資料顯示攝護腺癌治療目前是以手術為最多(43.2%)，手術方式可分為傳統開腹式、腹腔鏡輔助及達文西機械手臂輔助三種方式，但國內針對攝護腺癌的相關研究多以評估療效為主，癌症病患手術後的生活品質鮮少被討論。因此本研究目的要了解經醫師診斷為攝護腺癌並接受達文西機械手臂輔助根除性攝護腺切除手術病患之生活品質差異。研究期間為2009年4月至2010年3月，於中部某醫學中心泌尿外科病房進行連續收案，手術前一天利用問卷進行面對面訪談收集資料，手術後三個月以郵寄問卷進行第二次調查，有效問卷37份。使用之問卷包括:自擬式問卷、國際攝護腺症狀評分標準(international prostate symptom score;IPSS)、國際勃起功能指標問卷簡版(international index of erectile function-5; IIEF-5)、歐洲癌症研究與治療組織生活品質核心問卷(the European Organization for Research and Treatment of Cancer C-30; EORTC QLQ-C30)、攝護腺癌特殊性問卷(EORTC QLQ-PR25)。資料編碼後建檔，以SPSS 12.0 for Windows中文套裝軟體進行描述性統計、t檢定及單因子變異數分析(one-way ANOVA)。研究發現手術前癌症的臨床分期為早期(T1c)有17人(45.9%)，手術後的實際病理分期卻多為晚期(T3)有16人(43.2%)，手術後病理分期對開刀後三個月的病患整體生活品質影響無顯著差異；病患手術後性勃起功能有顯著障礙，因為疾病與治療過程讓病患自己覺得缺乏男人味的程度比手術前嚴重，其結果有顯著差異(P<0.05)。術後三個月追蹤發現，整體排尿功能(IPSS)在無顯著差異，而且病患手術後的排尿次數與尿急困擾症狀比手術前多，結果有顯著差異(P<0.05)，但穿戴尿片的困擾問題(EORTC QLQ-PR25)其術後有顯著改善(P<0.001)。手術後病患的情緒緊張程度比手術前減輕。 本研究提供僅提供攝護腺癌病患接受達文西機械手臂輔助手術後三個月之生活品質狀態，無法與其他手術方式做比較；病患手術後排尿功能、性功能的改善狀態及癌症進展情況對生活品質之影響仍須長時間追蹤。
並列摘要
Given that patients with localized prostate cancer now routinely survive for a considerable longer period of time, evaluation of patients’ quality of life after its treatments has been as important as evaluating their quantity of life. Consequently, it is critical to gain a better understanding of all the facts that could influence both the short-term and long-term functional performance and health-related quality of life in patients with prostate cancer. In this study we evaluated the quality o life for patients receiving the da Vinci Robotic Radical Prostatectomy (RRP). From April 2009 through March 2010, 37 patients who received the surgery at a medical center located in central Taiwan were recruited into our study. Questionnaires measuring patients’ sexual functions, urinary functions, and quality of life were administered to these patients at one day before the surgery and three months after. Scoring differences between the pre- and post-treatment were analyzed to assess if the RRP was associated with higher functional performance and better quality of life. Findings indicated that, for these 37 patients underwent the RRP, no significant differences in their sexual and urinary functions were observed three month after the surgery. However, we did find improvement in some of their general quality of life measures three months after. We recognized that, due to time limitation, we could only compare the patients’ baseline scores with those of three month later. We speculate that a longer recovery time may be needed for significant improvements in functional performance and quality of life among patients receiving the RRP.