- 學位論文
探討影響上肢多汗症患者有無接受交感神經手術之相關因素及生活品質之差異
Exploring the factors that influence patients with upper limbyperhidrosis when undergoing thoracoscopic sympathectomy and their resulting changes in quality of life
摘要
研究背景及目的 多汗症是指身體某部位的排汗量較一般人為多，其可發生在頭、頸部、腋下、手掌、軀幹或是足底，其中以手掌及腋下部位的多汗症最使人可惱。目前全世界皆公認經腋下進入胸腔使用內視鏡上段交感神經截/阻斷術是最有效治療多汗症的手術方法，但是手術後部分患者會產生不良反應---代償性出汗。台灣執行內視鏡交感神經治療多汗症的手術經驗相當豐富，目前國內卻仍缺乏多汗症患者術後生活品質評估之研究報告。另外，臨床上發現接受手術的患者有急遽減少的趨勢，本研究一併探討其原因。 研究方法 本研究為一回溯性研究。以2000 年至今，中部某醫學中心共1673 例，因多汗症至門診就醫的患者為研究對象，以結構式問卷進行電話訪問。問卷內容含翻譯後多汗症患者生活品質評估表，及患者個人基本資料。將問卷回收後以Microsoft Office Excel 加以整理、定義並儲存，而後以統計分析軟體SPSS（statistical package for the social sciences）進行資料分析，最後以羅吉斯迴歸分析影響多汗症患者是否接受交感 神經手術的重要影響因素。 研究結果 對生活品質而言，接受交感神經手術之多汗症患者對於症狀影響生活品質的平均值較高。在考慮是否接受交感神經手術的因素比較，以術前症狀對生活品質的影響、接受手術的財務負擔、家人是否支持手術、年齡、是否曾接受其他非手術治療、就醫時是否有工作、醫師 是否鼓勵接受手術、是否考慮術後代償性出汗的嚴重度等八項為影響因素。而在代償性出汗方面，有高達90%的患者出現代償性出汗症狀，且嚴重代償性出汗高達72%。 結論 台灣執行內視鏡交感神經治療多汗症的手術成果並不如國外的高滿意度。雖然交感神經手術對於多汗症患者有提昇生活品質的實質幫助。想要提高多汗症患者接受交感神經手術的意願，必須從醫師的態度及詳細的解釋、重新定位交感神經的手術位置、減少術後代償性出汗的機會和嚴重度著眼才行。
關鍵字
多汗症、生活品質並列摘要
Background: Excessive palmar and axillary sweating are the most problematic symptoms in patients with hyperhidrosis. Patients who undergo thoracoscopic sympathectomy for this condition may experience post-op compensatory sweating. Even though Taiwan ranks high in the number of thoracoscopic sympathectomies done annually, there has not been any report on postoperative changes in quality of life as well as an explanation for the rapid decline in the number of patients with hyperhidrosis who choose surgical management. This research will explore and discuss the factors that influence patients with upper limb hyperhidrosis undergoing thoracoscopic sympathectomy and the resulting life quality changes. Methods: A retrospective study is performed on 1673 hyperhidrosis patients who were seen in a medical clinic in the central region of Taiwan from the year of 2000 to 2006. A structured questionnaire was used to collect data, which included the changes in the patient’s quality of life and patient’s basic information. In addition to analyzing the data objectively, a logistic regression analysis was also performed to determine the significant factors that influence the patient’s decision to undergo thoracoscopic sympathectomy. Results: The patients with hyperhidrosis who underwent thoracoscopic sympathectomy have much poor life quality . In addition, there are eight factors that are significant in influencing the patient’s decision in receiving a thoracoscopic sympathectomy (p<0.05). These factors include the effect of pre-operative symptoms on the patient’s quality of life, financial burden of receiving the surgery, the level of family support, age,the effectiveness of previous non-surgical treatments, the patient’s job status at the time of seeking medical help, the physician’s opinion, and the considerations on post-operative compensatory sweating. Our research also shows that 90% of the patients who has had thoracoscopic sympathectomy have symptoms of compensatory sweating, 72% of which have severe symptoms. Conclusions: Even though sympathectomy has actually improved the life qualities of patients with hyperhidrosis, to improve patients’ will of having sympathectomy as the treatment for hyperhidrosis, emphasis should be placed on physician’s professional attitude, detailed explanations of the surgical procedures, and the reduction of incidence of post-operative compensatory sweating and its severity.
參考文獻
延伸閱讀
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