頭頸部癌症病患術後三個月內肩頸功能與身體功能之探討

Shoulder Dysfunction and Physical Performance in Head and Neck Cancer Patients Receving Surgery – Three Month Changes

林家瑜(Chia-Yu Lin)

指導教授 ： 賴裕和

國立臺灣大學/醫學院/護理學研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.03081

摘要

頸部廓清術(Neck Dissection) 是大部份頭頸部癌症病患手術治療中最常合併的治療方式。由於手術過程中頸部廓清術或其他相關治療可能對脊副神經 (Spinal Accessory Nerve)有所損傷，而導致病患術後發生肩部功能受限或肩功能不全 (Shoulder Dysfunction)情形。故本研究目的為：（1）探討接受頸部廓清術後三個月內肩頸功能、身體功能狀態及疼痛之變化；（2）鑑別接受頸部廓清術後三個月期間病患身體功能改變之相關因子。本研究於台灣北部某醫學中心採手術前後縱貫式（Longitudinal）資料收集，為期三個月，訪談四個時間點（術前、術後一個月、術後二個月、術後三個月），採用結構式問卷收集資料，每次訪談時間約25-30分鐘，訪談內容包括基本資料表、肩痛及失能指數量表 (Shoulder Pain and Disability Index, SPADI)、簡易疼痛評估中文量表 (Brief Pain Inventory, BPI)、McGill疼痛簡短版量表 (Short-Form McGill Pain Questionnaire, SF-MGP)、身體功能狀態量表 (Karnofsky’s Performance Status, KPS)、症狀嚴重度量表 (Symptom Severity Scale, SSS）、頸部轉頭角度評估。並使用廣義推估方程式（Generalized Estimated Equation, GEE）分析預測身體功能狀態變化之相關因子。
本研究共收60名符案病患，研究結果顯示病患於術後三個月期間肩功能、頸部轉頭角度與身體功能狀態顯著下降；多數病患術後疼痛性質以酸痛、刺痛為主，術後的疼痛干擾、憂鬱、症狀困擾與肩功能不全呈正相關。且於頸部廓清術後一到三個月內，若病患有較好的肩功能、較低的焦慮憂鬱、較少的疼痛干擾與症狀嚴重度，在身體功能部分會有較好的表現。研究結果得知，頭頸部癌症病患接受手術後仍有許多身體復健相關問題，若能給予適切復健指導與照護，相信更能改善術後身體功能狀態之表現，進而增進日後生活品質。

關鍵字

頭頸癌 ； 頸部廓清術 ； 肩頸功能 ； 疼痛 ； 身體功能狀態

並列摘要

Neck dissection (ND) is one of the major procedures for most head and neck cancer receiving surgery. Due to the potential harm to the spinal accessory nerve from ND or other related treatments, patients might experience limited shoulder function or even dysfunction. The purposes of this study were to (1) explore the levels of neck and shoulder function, physical function, and pain problems in head and neck cancer patient receiving neck dissection within three months of operation (OP); and (2) identify the factors related to the changes of physical f performance over the first three months of receiving neck dissection. A 3-month longitudinal study with 5 time data collections (Pre-OP, 2 weeks Post-OP, and 1 to 3 months post OP) was conducted to recruit head and neck patients in a medical center in Northern Taiwan. Patients were assessed by Shoulder Pain and Disability Index, Brief Pain Inventory, Short-Form McGill Pain Questionnaire, Karnofsky’s Performance Status, Symptom Severity Scale and Background Information Form. The Generalized Estimating Equation (GEE) was used to analyze the factors related to the changes of physical performance.
A total of 60 subjects were recruited. The results showed the declining function in shoulder function, neck rotation angles and performance status in the first three months. Most of patients had pain characterized as aching and stabbing. Postoperative pain interference, depression and symptom severity were positively correlated with severity of shoulder dysfunction. Patients with better shoulder function, less anxiety, lower depression, less pain interference, and lower symptom severity reported to have better physical performance over the first three months of receiving neck dissection. The results suggest that head and neck patients receiving surgery still have many problems needed to be cared. With better care of these problems are necessary and it would better help patients’ recovery in their physical performance.

並列關鍵字

Head and Neck Cancer ； Neck Dissection ； Shoulder Function ； Pain ； Karnofsky’s Performance Status

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