接受胸腔鏡手術的肺癌患者的生活質量及其影響因素探討

早期肺癌以手術切除為主要治療，術後常見咳嗽、胸痛及呼吸困難等相關問題，而影響生活品質。本研究目的在於探討接受胸腔鏡手術之肺癌病患其基本特性、疾病治療和生理特徵對於生活品質的影響。於中部某醫學中心胸腔外科門診，採立意取樣選取共24位病患，使用結構性問卷，收集基本資料、癌症生活品質量表(EORTC QLQ-C30)及肺癌生活品質量表(EORTC QLQ-LC13)，完成實驗室檢驗、肺功能檢查及六分鐘行走測試，分別於術前、術後一個月及術後三個月進行，使用SPSS 20.0版本進行資料分析。研究結果如下：(1)Hb、Hct及albumin檢驗值、肺功能量計FVC及FEV1檢查和六分鐘行走測試之Borg scale量表及生活品質各次量表間，在術前、術後一個月及三個月均有顯著影響（p <.05）。(2)經由GEE Mode分析，對於整體功能：術後一個月及三個月分數低於術前，但術後一個月有顯著差異（p <.05），是重要的評估時間。而手術切口多寡、Hb和Hct檢驗值及Borg scale量表分數皆會影響整體功能之生活品質，是重要的預測因子。在整體健康：Hct是重要的預測因子，尤其在術後三個月生活品質是重要的預測指標。而整體症狀：lobectomy術式，在術後一個月及三個月整體症狀顯著高於術前，應加強評估術後影響生活品質的症狀及時治療和改善。最後在肺癌症狀：lobectomy及segmentectomy術式，術後肺癌症狀分數皆高於wedge術式，而術後一個月及三個月其Hb及Hct檢驗數值會影響其生活品質，應持續監測；因此術式、Hb、Hct檢驗值是肺癌症狀重要的預測指標。建議未來若能依肺癌不同術式病患，在術前、術後一個月及三個月各時間點，監測其可能預測生活品質重要的預測指標。針對問題而有計畫地設計改善方案，相信可改善肺癌病患術後整體的生活品質。

關鍵字

肺癌病患；胸腔鏡手術；生活品質

並列摘要

Early lung cancer is mainly treated with surgical resection, and the common postoperative problems such as cough, chest pain and dyspnea, after surgery, which affect the quality of life. The purpose of this study is to explore the quality of life and it’s impact factors among lung cancer patient receiving of thoracoscopic surgery. Using a repeat measure study design, and recruited 24 participants from the thoracic surgery department of a medical center in the Central of Taiwan. All participants completed the structured questionnaire included the basic data (characteristics, disease treatment and physiological), cancer quality of life scale (EORTC QLQ-C30) and lung cancer quality of life scale (EORTC QLQ-LC13), laboratory tests, lung function tests, and six-minute walk tests. Above data were collected before surgery, one month after surgery, and three months after surgery. Data were analyzed by SPSS 20.0 software. The results show that:(1) Pre, post 1 month, and post 3 months of surgery, the Hb, Hct and albumin test, spirometer FVC and FEV1 examination, Borg scale -six minute walk test and quality of life score, have a significant difference (p <.05). (2) According to GEE mode analysis, the quality of life of post 1 and post 3 months of surgery was lower than that pre-surgery, but only between pre surgery and post 1 month of surgery had significant difference(p <.05). So that, post 1 month of surgery, which was an important time point for evaluation. The number of surgical incisions, Hb and Hct test values, and Borg scale scores, which are significant predictors about the quality of life of overall function. The quality of life of overall health: Hct is a significant predictor, especially on the post-surgery 3 months, which is a significant predictor. The quality of life of overall symptoms: Surgical method when adopted lobectomy, post 1 month and post 3 months, overall symptoms were significantly higher than pre-surgical. In hence, it's necessary to strengthen the importance of postoperative symptoms assessment, which affect the quality of life and timely treatment effectiveness. Finally, the symptom scores of lung cancer in lobectomy and segmentectomy patients, which were higher than those who in wedge resection, and the Hb and Hct test values in post-surgery 1 month and 3 months would affect their quality of life, which should be monitored continuously. Therefore, the surgical method, Hb and Hct test values are important predictors of lung cancer symptoms. It is suggest that in the future, according to different surgical methods of lung cancer patients, above indicated important predictors of quality of life, which should be monitored pre, post 1 month, and post 3 months of surgery continuously. It is believed that the overall quality of life of lung cancer patients could be improved by designing the care plan according to the assessment predictors.