- 學位論文
結直腸癌病人術後六個月內之性功能改變及其影響因素
Change of Sexual Function and its Related Factors in Patients with Colorectal Cancer after Surgery within Six Months
摘要
結直腸癌發生率逐年攀升且有年輕化趨勢，近幾年治療的進步使病人存活率逐年增加，生活品質的議題備受重視，其中性生活是影響生活品質的重要因素，但目前性議題在臺灣較少被重視及探討且以往的研究多採橫斷式研究設計，顯少將術前性功能列入評估，亦未將人格特質因素列入影響性功能之考量，因此本研究目的為探討：(1)結直腸癌病人手術前後六個月內Type D人格特質、症狀嚴重程度及男女性功能之現況及改變；(2)手術前後六個月內結直腸癌病人性功能的差異；(3)結直腸癌病人術手術前後六個月內性功能改變影響因素，包括人口學特性、疾病及治療相關性、症狀相關資料及Type D人格特質。 本研究自105年1月3日至105年12月1日於台北市某醫學中心大腸直腸外科病房進行收案，採用縱貫式研究方法及立意取樣，收案時間點包含手術前一個月、手術後一個月、手術後六個月，藉由問卷收集資料，包括個人基本資料、疾病相關資料表、症狀嚴重程度評估、女性性功能指數、國際勃起功能指標量表、臺灣版DS14修訂版(DS14-TR)，資料分析方法包括描述性統計和推論性統計，藉由描述性統計分析病人基本屬性、疾病相關資料、症狀嚴重程度評估、Type D人格特質及男女性功能；以重複測量變異數分析(Repeated measure ANOVA)分析結直腸癌病人手術後六個月內症狀嚴重程度、Type D人格特質及男女性功能之改變，以卡方檢定(Chi-square)分析結直腸癌病人性功能的差異，以廣義估計方程式(Generalized estimating equation, GEE) 探討結直腸癌病人術後六個月內性功能改變影響因素。本研究總共有99人完成手術前一個月的資料收集，83人完成手術後一個月的追蹤、78人完成手術後六個月的追蹤，研究結果顯示：(1)接受手術前後六個月，整體症狀嚴重程度屬輕微，且手術前後六個月整體症狀嚴重程度無顯著差異(p = 0.106)，從個別症狀分析有六項症狀在手術前後六個月有顯著的不同，個別症狀分數隨著時間增加包括噁心(p = 0.017)、不自主放屁(p = 0.046)及排便次數增加(p = 0.001)，個別症狀分數手術後一個月分數下降然後手術後六個月分數上升的症狀包含掉髮或毛髮減少(p = 0.016)、腹瀉(p = 0.012)及焦慮(p = 0.003)；(2)Type D人格特質總分於手術後一個月顯著低於手術前一個月(p = 0.006)，而負向情感部分手術後一個月(p = 0.003)及手術後六個月(p = 0.046)分數顯著低於手術前一個月；(3)手術前後六個月內性功能變化的部分，結直腸癌男性病人在國際勃起功能指標量表總分(p < 0.001)及次量表包含勃起(p < 0.001)、性高潮(p < 0.001)、性交滿意度(p < 0.001)、性慾望(p = 0.001)及整體滿意度(p = 0.006)等性功能，於手術後一個月顯著低於手術前一個月，手術後六個月分數上升。女性性功能指數總分(p = 0.007)及次量表包含性興奮(p = 0.003)及性高潮(p = 0.011)手術後一個月分數顯著低於手術前一個月，然後手術後六個月分數上升；(4)手術前後六個月內結直腸癌病人性功能障礙無顯著差異(P > 0.05)；(5)以廣義估計方程式之邏輯斯迴歸分析影響研究參與者性功能變化之重要因子，研究結果發現結直腸癌病人在手術後一個月(Odds ratio = 5.008；p = 0.004)、年齡越大(Odds ratio = 1.091；p = 0.002)、女性(Odds ratio = 35.170；p < 0.001)、化學治療病人(Odds ratio = 3.899；p < 0.011)具有性功能障礙的風險越高。 性功能障礙是結直腸癌病人接受手術後常見的問題，因此臨床照顧者應在結直腸癌病人手術後一個月，根據病人年齡、性別及接受化學治療病人者，由健康照護人員主動開啟性功能議題，依病人個別性給予指導及早期轉介。
並列摘要
The incidence of colorectal cancer (CRC) is increasing and patient is younger than before. Recently, the advanced multidisciplinary treatments has led to a substantial improvement in prognosis, which also rise up the issue for the quality of life, and one of the main factory for it is the sexual function. However, it has limited understandings and less been discussed on this sexual function topic for those CRC patients in Taiwan. The previous studies are mostly predominantly cross-sectional design, lacking of preoperative sexual function evaluation and discussion about Type D personality with sexual issue. Therefore, the purposes of this study were to explore (1)changes of severity of symptom, Type D personality and sexual function after surgery within six months; (2)the difference of sexual function between colon and rectal cancer after surgery within six months; and (3)the significant factors related to sexual function in patients with CRC after surgery within six months. A longitudinal design study was conducted by recruiting the CRC patients at colorectal surgical wards in a medical center in Taipei from 3rd January to 1st December in 2016. Participants were selected by purposive sampling. Data were collected during preoperative about one month (T0), and one-(T1) and six-month (T2) after surgery. Questionnaires included demographic information, disease-related characteristics, severity of symptom, Female Sexual Function Index, International Index of Erectile Function and DS14-TR. Data analysis included descriptive and inferential statistics. The descriptive statistics was used to analyze the demographic and disease-related information, severity of symptom, Female Sexual Function Index, International Index of Erectile Function and DS14-TR. Inferential statistics contained repeated measure ANOVA, Chi-square test and generalized estimating equation. Repeated measure ANOVA was used to analysis the change of severity of symptom, sexual functions and Type D personality within six months. Chi-square test was used to analysis the difference of sexual function between colon and rectal cancer after surgery within six months. Generalized estimating equation was used to explore change of sexual function and its related factors in patients with CRC after surgery within six months. A total of 99, 83, and 78 patients completed the survey at T0, T1 and T2, respectively. The results showed that (1)the severity of symptom was mild and the average of symptom was no significant change in patients with CRC after surgery within six months (p = 0.106). But the individual symptoms were significant change in patients with CRC after surgery within six months. The symptoms including nausea (p = 0.017), increasing frequency of stool (p = 0.001) and unintentional gas (p = 0.046) increased over times. The other symptom including loss of hair (p = 0.016), diarrhea (p = 0.012) and anxiety (p = 0.003) decreased at T1 and increased at T2. (2)Type D personality (p = 0.006) decreased significantly at T1 as compared with T0. Negative affectivity decreased significantly at T1 (p = 0.003) and T2 (p = 0.046) as compared with T0. (3)International Index of Erectile Function (p = 0.001) and subscales included erectile function (p < 0.001), orgasmic function (p < 0.001), intercourse satisfaction (p < 0.001), sexual desire (p = 0.001) and overall satisfaction (p = 0.006) were decreased significantly at T1 and increased at T2. Female Sexual Function Index (p = 0.007) and subscales including arousal (p = 0.003) and orgasm (p = 0.011) decreased significantly at T1 as compared with T0. (4)Sexual function was no significantly difference between colon and rectal cancer after surgery within six months (P > 0.05). (5)Generalized estimating equation was used to explore change of sexual function and its related factors. The result showed that the higher risk of sexual dysfunction in patients with CRC were in the first month after surgery (Odds ratio = 5.008；p = 0.004), older age (Odds ratio = 1.091；p = 0.002), female (Odds ratio = 35.170；p < 0.001) and receiving chemotherapy (Odds ratio = 3.899；p = 0.011). Sexual dysfunction is a common problem in patients with CRC after surgery. Therefore, health care profession should raise sexual issue in patients with CRC with high risk population such as older age and female in the first month after surgery or during chemotherapy.
參考文獻
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