膽囊切除術後之健康相關生活品質探討

膽囊切除手術有傳統剖腹式膽囊切除術(Open Cholecystectomy, OC)及腹腔鏡膽囊切除術(Laparoscopic Cholecystectomy, LC)兩種。國外有許多研究比較剖腹式與腹腔鏡醫療處理，且支持腹腔鏡技術在早期術後階段具有較佳的優勢，但國內只有數量有限的文獻報告比較這兩種技術在後續追蹤期間的生活品質。故本研究將針對比較這兩種膽囊切除術技術在短期追蹤期間內，評估病患生活品質及臨床效果。本研究評估2007年2月13日至2007年11月20日年間在兩間醫學中心進行膽囊切除術的297位病患(OC：38及LC：259)。使用疾病別胃腸功能生活品質指數中文版問卷(GIQLI)及整體性台灣版SF-36問卷之測量工具，以進行重複測量GEE、Effect Size、Bootstrapping及MCID統計方法，探討不同評估工具在不同測量構面之改善幅度，調查病人術後療效(Outcomes)之改變趨勢及其相關危險因子。 LC病患在術後三個月及六個月，HRQoL改善趨勢呈顯著正相關(P<0.001)， OC病患在術後三個月及六個月除社會功能外皆達顯著正相關(P<0.001)。GIQLI 題項中，些微改善組之4項定錨試題的效應值(0.38-0.49)，高於相同組(0.25-0.38)，顯示MCID的使用與解釋價值。再者年齡的差異，對於膽囊切除手術病患術後HRQoL改善具有顯著意義(p<0.05)。 GIQLI與SF-36問卷中，均可觀察到支持腹腔鏡手術具有較佳的短期生活品質。在ES的反應性估計間，顯示GIQLI的有效性估計普遍高於SF-36，更具有較佳之疾病特定性評量，能提供臨床人員與健康研究人員評估治療結果。病患特性中年齡對生活品質預後結果具有重要且獨立的影響性，術前功能狀況對於術後HRQoL改善亦非常重要。

關鍵字

膽囊切除手術； GIQLI ； SF-36 ； HRQoL

並列摘要

The cholecystectomy can be divided into open cholecystectomy (OC) and laparoscopic cholecystectomy (LC). There are many international studies abroad comparing open medical procedures with traditional medical procedures, which supports superior benefits in the early postoperative stage of LC; but there are limited studies comparing the quality of life during the follow-up period between these two techniques in Taiwan. The study compared these two cholecystectomy techniques during the short follow-up period, and evaluated the quality of life and clinical results of patients. We evaluated 297 patients (OC: 38, LC: 259) conducting cholecystectomy in two medical centers between February 13, 2007 and November 20, 2007. We explored the improvement between different dimensions of assessment tools such as Gastrointestinal Quality of Life Index (GIQLI) and Global Taiwan SF-36 Questionnaire by repeated measures of GEE, effect size, bootstrapping and MCID, to investigate the improvement tendency of outcomes and the related risk factors. Not only the improvement tendency of HRQoL between 3 and 6 months post-operation of LC showed significant positive correlation (p < 0.001), but also the improvement tendency of HRQoL between 3 and 6 months post-operation of OC (p < 0.001), except for the social function. Among GIQLI items, the effect sizes of four anchor items in the mild improvement group (0.38-0.49) were higher than the similiar group (0.25-0.38), which demostrated the usage and interpretation values of MCID. Furthermore, the difference of age has significant influence on the HRQoL improvement after cholecystectomy (p<0.05). We could find evidence supporting superior short term quality of life for LC in both GIQLI and SF-36. The responsiveness estimation of ES suggested that the efficacy estimation of GIQLI was higher than SF-36 in general, with much better disease-specific measures, which could provide outcome measures for clinical sfaff and health professionals. Among the characteristics of patient, age has important and independent effect on QoL outcomes. Besides, the pre-operative function status was also very important to the post-operation HQRoL improvement.