膽囊切除病患之長期縱貫性研究

膽囊切除為目前相當普遍的手術，但鮮少研究探討長期的生活品質，因此，本研究目的為透過長期追蹤，探討膽囊切除病患之改善趨勢、比較GIQLI與SF-36評估量表的反應性、以Piecewise Liner Regression預測健康相關生活品質(HRQoL)的閾值，並以病患特性、醫療機構特性、醫療照護品質及術前功能狀況進行探討影響健康相關生活品質(HRQoL)之重要因素。本研究針對2007年2月至2008年2月間，共有400位於兩家醫學中心接受膽囊切除患者為研究樣本，追蹤時間點分別為術前、術後六月、術後一年及術後二年。分析方法包含量表的反應性分析(Effect Size、Standardized Response Mean、Minimal Detectable Change、Minimal Clinically Important Difference、Bootstrapping)、廣義估計方程式(GEE)、Piecewise Liner Regression預測模式及MAPE評估預測模式。本研究之樣本以女性居多(57.25%)，平均年齡為55.95(SD：14.67)歲，<65歲佔71.00%。研究結果顯示患者於術後六月皆達顯著改善，術後一年及二年在情緒、生理功能分數、心理健康、一般健康狀況仍有顯著改善，且呈現穩定的健康狀況；而透過反應性分析，測量GIQLI與SF-36的反應性，透過MCID分析，GIQLI的四個構面可測出顯著的改善(p<0.001)，而「稍微改善」的分數分別為症狀14.18、情緒21.37、生理20.88、社會13.46，並再以Bootstrapping分析，證實GIQLI的反應性較SF-36佳；然後，採用Piecewise Liner Regression預測術後健康相關生活品質，大約可預測到術後12年其HRQoL癒後會顯著變差，並以MAPE做檢定，發現此預測模式相當準確(MAPE≦20%)；最後，在控制時間因素後，以GEE分析重要的影響因素，發現術前功能狀況、BMI、過去做過腹部手術及併發症(P<0.05)為主要的影響因素，且皆與評估量表的構面呈正相關。透過長期的追蹤，膽囊切除患者術後皆擁有良好的生活品質，建議醫療機構及健康保險機構應對患者建立優良的術後追蹤管理。

關鍵字

膽結石； GIQLI ； SF-36 ；健康相關生活品質(HRQoL) ；反應性(responsiveness) ； Piecewise Liner Regression

並列摘要

Currently, the Cholecystectomy is a very common surgery, but there are little studies about long-term quality of life. Therefore, the purposes of this research are to evaluate changing trend of patients who accepted the Cholecystectomy, to compare the responsiveness of the GIQLI and SF-36, to predict the threshold of Health-related Quality of Life (HRQoL) by using Piecewise Liner Regression method and to explore the relationship of important factors and HRQoL. There are 400 patients prospectively included into the study from Februarys 2007 to Februarys 2008. All patients completed both questionnaires at preoperative, 6 months, 1 and 2 years postoperatively. The analysis methods included descriptive statistics, responsiveness of questionnaires (ES, SRM, MDC, MCID, bootstrapping), The Generalized Estimating Equations (GEE), and Piecewise Liner Regression. In the research sample, there were 57.25 percent females, mean age 55.95 (SD 14.67), and 71.00% were under 65 years old. According to the results, they showed the significant improvement at 6 months, and became stable on emotion, PF, MH and GH at 1 and 2 years. In addition, the four dimensions of GIQLI could examine patients’ outcome significantly (p<0.001) by MCID,and MCIDs of 14.18, 21.37, 20.88, and 13.46 points respectively for scores on symptom, emotion, physiology and social subscales for patients responded with” somewhat better.”Then, this study compared the responsiveness on GIQLI which was better than SF-36 by bootstrapping. Also, the study used Piecewise Liner Regression to predict the HRQoL after the surgery, and the patients could keep improving until the threshold level 12 years. We also found that this model was quite accurately(MAPE≦20%). This study showed the important factors of HRQoL, included preoperative functional status, BMI, previous abdominal surgery and complication (p<0.05) which were positively related to many dimensions. In conclusion, all patients had better HRQoL after Cholecystectomy by the long-term follow. Thus, hospitals and health insurance institutions should establish the perfect management of postoperative follow-up for patients.