肝癌病患接受肝切除術之健康相關生活品質探討

Health-Related Quality of Life of Hepatocellular Carcinoma Patients Underwent Hepatectomy

凌宜男(I-Nan Lin)

指導教授 ： 邱亨嘉

高雄醫學大學/健康科學院/醫務管理學研究所/碩士(2008年)

摘要

研究目的
本研究目的主要在於探討回溯性及前瞻性研究之肝切除肝癌病患的健康相關生活品質，並預測影響健康相關生活品質之重要因子，最後為探討一般性癌症病患生活品質問卷(EORTC QLQ-C30)與肝癌特定生活品質問卷(EORTC QLQ-HCC18)之相關性。

研究方法
本研究同時採用回溯性橫斷面及前瞻性縱貫面的研究設計，問卷調查期間為2007年7月至2008年4月30日，主要以高雄市某醫學中心肝膽胰外科門診及病房之接受肝切除術的原發性肝癌病患為研究樣本。在回溯性部份，利用結構式問卷針對術後12個月(n=35)及24個月(n=43)之肝切除肝癌病患進行健康相關生活品質調查；在前瞻性部份則針對術前、術後6週及術後12週(n=33)進行調查。資料以次數及百分比或平均值±標準差呈現，利用獨立樣本t檢定、卡方檢定、重覆量數單因子變異數分析、複迴歸分析、GEE迴歸模式及皮爾森積差相關進行統計分析。

研究結果
本研究接受肝切除之肝癌病患皆有中等程度的生活品質。回溯性研究結果顯示，術後12個月及24個月除了身體心像達顯著差異外，其他構面均無差異，呈現穏定狀態；前瞻性研究結果顯示，QLQ-C30之角色功能、情緒功能、疲倦及疼痛構面達顯著差異；QLQ-HCC18之疲倦、營養及疼痛構面達顯著差異。而肝癌病患在術前的情緒功能最差，但在術後6週明顯改善；術後6週之疲倦及疼痛症狀顯著較差，但在術後12週有漸漸恢復的趨勢。回溯性研究發現總住院天數、有無職業、併發症為同時影響QLQ-C30及QLQ-HCC18之因子，總住院天數較短、有職業、無併發症之肝癌病患的健康相關生活品質較好；前瞻性研究發現時間為同時影響QLQ-C30及QLQ-HCC18之因子，肝癌病患接受肝切除術後之健康相關生活品質顯著較術前差。在相關性分析中，QLQ-C30之整體生活品質與QLQ-HCC18之疲倦構面大致與所有構面皆呈現顯著相關性。本研究發現在QLQ-C30方面，整體生活品質與疲倦的相關性最高，呈顯著負相關；在QLQ-HCC18方面，身體心像與營養構面的相關性最高，呈顯著正相關；在QLQ-C30及QLQ-HCC18兩份問卷的相關性中，發現兩組相同之疲倦構面的相關性最高，呈顯著正相關。

結論與建議
研究發現肝癌病患在術後的健康相關生活品質較術前差，尤其以疲倦和疼痛的情形最為顯著，導致生活品質降低。因此本研究建議醫護人員應加強對病患疼痛及疲倦處置的介入措施及相關衛教，以緩解病患身體上之疼痛、改善疲倦程度為優先考量，減少其對生活品質的衝擊。

關鍵字

肝癌 ； 肝切除術 ； 健康相關生活品質 ； EORTC QLQ-C30 ； EORTC QLQ-HCC18

並列摘要

Purpose
The purpose of this research is to discuss the health-related quality of life (HRQOL) of hepatocellular carcinoma (HCC) patients with hepatectomy and also to detect the most important factors which affect the HRQOL. Last but not least, this study will also discuss the correlation between EORTC QLQ-C30 and EORTC QLQ-HCC18.

Method
This research uses both methods of retrospective cross-sectional and of prospective longitudinal study design. Questionnaire examine period is from July of 2007 to 30th of April, 2008. The major samples of studying are from Hepato-biliary-pancreatic Surgery outpatient in Kaohsiung’s medical center and ward to underwent hepatectomy of HCC patients. Regarding retrospective study, by using structural questionnaire, we could examine the HRQOL of HCC patients who underwent hepatectomy either in the 12 months after operation (n=35) or in the 24 months after operation (n=43). For the prospective study, we focused on preoperation, 6 weeks after operation and 12 weeks after operation(n=33). In this research, all data are presented in percentages or the mean ± SD value. In the statistical analysis point of view, we are using Student t-test、X2 and Fisher’s exact tests、Repeated Measure one-way ANOVA、Multiple linear regression analysis、GEE model analysis and Pearson’s correlation for this research.

Result
In this study, all HCC patients who underwent hepatectomy have average of HRQOL. In the result of retrospective study, it has only significant difference in body image within 12 months after operation and 24 months after operation, but not in other domains. In the result of prospective study, there are significant difference in the role functional, emotional functional, fatigue and pain of QLQ-C30 in prospective study. Additionally, QLQ-HCC18 of fatigue, nutrition, and pain are also showing major dissimilarity. HCC patients have bad emotional functional at preoperation; but, this situation could be improved in 6 weeks after operation. However, they show the symptoms of fatigue and pain seriously in 6 weeks after operation. This negative behavior could improve in 12 weeks after operation. In retrospective study, how many length of stay totally in the hospital, whether having an occupation and whether having complications are all factors which would affect QLQ-C30 and QLQ-HCC18. Patients will have better HRQOL, if HCC patient have shorter staying in the hospital, having an occupation and non-complications. In prospective research, time factor is the one which affects both factors of QLQ-C30 and QLQ-HCC18 at the same time. Compared with postoperations, the HRQOL of HCC patients has major difference in preoperation. In correlation analysis, it is positive correlation in the Global health status /QOL of QLQ-C30, the fatigue of QLQ-HCC18, and all domains. On one hand, QLQ-C30 is sanded for the highest negative correlation in Global health status /QOL and fatigue. On the other hand, QLQ-HCC18 is represented the highest positive correlation in body image and nutrition. In the questionnaires between QLQ-C30 and QLQ-HCC18, the study presents the positive correlation, especially in the both fatigue domains.

Conclusion and suggestion
In this research, we discover that the HRQOL of HCC patients is worse in postoperation than preoperation, especially significantly in fatigue and pain that lower the HRQOL. Hence, we will suggest that medical care workers are better to take care of patients more in the measure of pain and fatigue and the related health teaches in order to alleviate patients’ body pain, improve patients’ fatigue degree and reduce the impact of the HRQOL.

並列關鍵字

Hepatocellular Carcinoma ； Hepatectomy ； Health-Related Quality of Life ； EORTC QLQ-C30 ； EORTC QLQ-HCC18

參考文獻

中文部份

王麗惠、劉芹芳.(2007). 消化系統癌症惡病質病患的個人基本屬性、營養狀況與日常生活活動能力及生活品質之相關性. 護理雜誌, 54(3), 33-41.

朱月英、郭碧照.(2006). 食道癌患者生活品質及其相關因素研究. 實證護理, 2(2), 127-136.行政院衛生署. (2007). 台灣地區主要死因. 衛生統計資訊網. http://www.doh.gov.tw/statistic/data/衛生統計叢書2/96/記者會專區/表8.xls

吳耀銘、李伯皇. (2006). 肝癌. 台灣醫學, 10(4), 482-487.

李佳倫. (2006). 結直腸癌病患手術前後生活品質變化及其相關因素調查. 高雄醫學大學, 高雄.