SF-36量表评价LAVH对患者生存质量的影响
摘要
研究背景:
子宫切除术是妇科最常见的手术之一,适用于功能性子宫出血、子宫肌瘤、子宫脱垂、子宫内膜异位症、盆腔疼痛、癌前期病变和早期子宫恶性肿瘤。在美国,该手术在所有妇科手术中居第2位,估计每年需要行子宫切除的病例多达50～60万。在瑞典和英国,每年接受子宫全切术的女性比例达到6～8‰。而我国,每年有近100万名妇女因为各种子宫疾患接受子宫全切术。子宫切除术使众多患有妇科疾病的女性远离了病痛,给她们的身心带来了健康。
历史以来,子宫全切的途径有多种,在20世纪90年代以前,一直只有腹式全子宫切除术(Toral Abdominal Hysterectomy,TAH)和阴式全子宫切除术(Total Vaginal Hysterectomy,TVH)两种传统的术式。随着腹腔镜技术的发展和设备的改进,国内外学者经过不断努力使妇科腹腔镜手术取得了巨大的进步。自1989年Reich医生实施了首例腹腔镜辅助阴式子宫切除术(Laparoscopic Assisted Vagihal Hysterectomy,LAVH)以来,腹腔镜技术在妇科领域的应用已进入了一个崭新的发展阶段,扩大了妇科手术的领域。相对于TAH和TVH而言,LAVH具有损伤小、术后恢复快、疼痛轻等优点,它不仅去除了病变的子宫体,而且切除了可能有潜在病变的子宫颈,保证了腹壁的完整性,充分显示出微创手术的优越性。此外,与其他腹腔镜下子宫切除术式相比,它还具有更为广泛的适应证,并克服了文献所报道的镜下术后容易发生的如宫颈残端出血、感染以及恶性肿瘤扩散等并发症高的弊端。
Introduction:Hysterectomy is one of the most commonly gynecological performed operations, which is performed for functional uterine bleeding、 hysteromyomas、 uterus prolapse、 adenomyosis、 pelvic pain、 precancerous lesion and early stage of maniglant uterine tumors. It ranks second among all major gynecological operations in the United States. It has been estimated that about one third of women will have undergone hysterectomy by the age of 65 years, In Sweden and United Kingdom , 6~8‰ women receive hysterectomy annually and the number of our courtry is 1 million.Tranditionally, hysterectomy is performed abdominally or vaginally. As increasing interest in laparoscopic hysterectomy has occurred since it was first reported in 1989 by Reich H. It presents more and more advantages over conventional abdominal hysterectomy .They are the avoidance of a large abdominal incision, reduction of postoperative pain and decreasing intraoperative blood loss, shortening of hospital stay and a quicker return to normal activities. So more and more gynecologists and patients would receive laparoscopical hysterectomy. It is a safe, reliable and mini-invasive operation in the treatment of some gynecological diseases, and has predictable outcome.
Quality of life is a new conception going withbiology-psychology-social medical pattern changing. So people are looking for a method to messure this. SF-36 is such a tool, which is simple but effective. So it was used abroadly by international medical organization. It has 36 short items for investigation. Recently, it has been widely used in many fields by lots of international orgnization, but there' s no data about it in gynecological disease especial in women with LAVH.Objectives:To discuss quality of life of patients suffered from LAVH, and to investigate the feasibilility and safety of laparoscopic management of women with benign gynecological diseases, and to observe the operative clinical effction, and also present a new method for quality of life messurement.Methods:Design: A prospective clinical study. Setting: The Af iliated Sir Run Run Shaw Hospital of Zhejiang University. Samples:A number of 160 cases underwent the procedure by laparoscopic assisted vaginal hysterectomy for benign gynecological diseases from July 2003 to March 2005 was recruited. Main outcome measures: Concerning the 36 items listing by SF-36. Statifical analysis:The statistical SPSS with version 12.0 was used methods included t test or one-way ANOVA for data for mean comparison, chi-square test for enumeration data. A lvalue less than 0.05 was considered significant.Results:160 women of 175 completed the survey before and after the operation, the ratio is 91.42%. No obvious difference between their age, status of
marriage, income, education and disease. SF-36 which was applied has good validity, reliability and responsiveness. We can observe significant difference in PF, RP, BP, GH, SF and MH before the operation and 6 months after the operation. And also, the operative age, status of marriage, income, education and disease has some infection on their quality of life.Conclusions:Laparoscopic assisted vaginal hysterectomy is a safe procedure and it has many advantages for more application.The SF-36 used for quality of life messurement is suitable and effective. Patients with LAVH got a better prognosis after the operation.
子宫切除术是妇科最常见的手术之一,适用于功能性子宫出血、子宫肌瘤、子宫脱垂、子宫内膜异位症、盆腔疼痛、癌前期病变和早期子宫恶性肿瘤。在美国,该手术在所有妇科手术中居第2位,估计每年需要行子宫切除的病例多达50～60万。在瑞典和英国,每年接受子宫全切术的女性比例达到6～8‰。而我国,每年有近100万名妇女因为各种子宫疾患接受子宫全切术。子宫切除术使众多患有妇科疾病的女性远离了病痛,给她们的身心带来了健康。
历史以来,子宫全切的途径有多种,在20世纪90年代以前,一直只有腹式全子宫切除术(Toral Abdominal Hysterectomy,TAH)和阴式全子宫切除术(Total Vaginal Hysterectomy,TVH)两种传统的术式。随着腹腔镜技术的发展和设备的改进,国内外学者经过不断努力使妇科腹腔镜手术取得了巨大的进步。自1989年Reich医生实施了首例腹腔镜辅助阴式子宫切除术(Laparoscopic Assisted Vagihal Hysterectomy,LAVH)以来,腹腔镜技术在妇科领域的应用已进入了一个崭新的发展阶段,扩大了妇科手术的领域。相对于TAH和TVH而言,LAVH具有损伤小、术后恢复快、疼痛轻等优点,它不仅去除了病变的子宫体,而且切除了可能有潜在病变的子宫颈,保证了腹壁的完整性,充分显示出微创手术的优越性。此外,与其他腹腔镜下子宫切除术式相比,它还具有更为广泛的适应证,并克服了文献所报道的镜下术后容易发生的如宫颈残端出血、感染以及恶性肿瘤扩散等并发症高的弊端。
Introduction:Hysterectomy is one of the most commonly gynecological performed operations, which is performed for functional uterine bleeding、 hysteromyomas、 uterus prolapse、 adenomyosis、 pelvic pain、 precancerous lesion and early stage of maniglant uterine tumors. It ranks second among all major gynecological operations in the United States. It has been estimated that about one third of women will have undergone hysterectomy by the age of 65 years, In Sweden and United Kingdom , 6~8‰ women receive hysterectomy annually and the number of our courtry is 1 million.Tranditionally, hysterectomy is performed abdominally or vaginally. As increasing interest in laparoscopic hysterectomy has occurred since it was first reported in 1989 by Reich H. It presents more and more advantages over conventional abdominal hysterectomy .They are the avoidance of a large abdominal incision, reduction of postoperative pain and decreasing intraoperative blood loss, shortening of hospital stay and a quicker return to normal activities. So more and more gynecologists and patients would receive laparoscopical hysterectomy. It is a safe, reliable and mini-invasive operation in the treatment of some gynecological diseases, and has predictable outcome.
Quality of life is a new conception going withbiology-psychology-social medical pattern changing. So people are looking for a method to messure this. SF-36 is such a tool, which is simple but effective. So it was used abroadly by international medical organization. It has 36 short items for investigation. Recently, it has been widely used in many fields by lots of international orgnization, but there' s no data about it in gynecological disease especial in women with LAVH.Objectives:To discuss quality of life of patients suffered from LAVH, and to investigate the feasibilility and safety of laparoscopic management of women with benign gynecological diseases, and to observe the operative clinical effction, and also present a new method for quality of life messurement.Methods:Design: A prospective clinical study. Setting: The Af iliated Sir Run Run Shaw Hospital of Zhejiang University. Samples:A number of 160 cases underwent the procedure by laparoscopic assisted vaginal hysterectomy for benign gynecological diseases from July 2003 to March 2005 was recruited. Main outcome measures: Concerning the 36 items listing by SF-36. Statifical analysis:The statistical SPSS with version 12.0 was used methods included t test or one-way ANOVA for data for mean comparison, chi-square test for enumeration data. A lvalue less than 0.05 was considered significant.Results:160 women of 175 completed the survey before and after the operation, the ratio is 91.42%. No obvious difference between their age, status of
marriage, income, education and disease. SF-36 which was applied has good validity, reliability and responsiveness. We can observe significant difference in PF, RP, BP, GH, SF and MH before the operation and 6 months after the operation. And also, the operative age, status of marriage, income, education and disease has some infection on their quality of life.Conclusions:Laparoscopic assisted vaginal hysterectomy is a safe procedure and it has many advantages for more application.The SF-36 used for quality of life messurement is suitable and effective. Patients with LAVH got a better prognosis after the operation.
引文
[1] Summitt RL. Laparoscopic-assisted vaginal hysterectomy: a review of usefulness andoutcomes. Clin Obstet Gynecol. 2000;43: 584-593
[2] Wilcox LS, Koonin LM, Pokras R, et al, Hysterectomy in the united states, 1988-1990. Obstet Gynecol. 1994;83: 549-555
[3] Marana R, Busacca M, Zupi E, et al. Laparoscopiciiy assiasted vaginal hysterectomy versus total abdominal hysterectomy: a prospective, randomized, multi-center study. Am J Obstet Gynecol. 1999;180: 270-275
[4] Meeks GR, Harris RL. Surgical approach to hysterectomy: Abdominal, laparoscopy asissted, or vaginal. Clin Obstet and Gyn. 1997;40: 886-894
[5] Reich H, et al. Laparoscopic hysterectomy. J Gynecol Surg, 1989;5: 213-21
[6] Labib M, Palfrey S, Paniagua E, et al. The postoperative inflammatory responses to injury following laparoscopiclly assisted vaginal hysterectomy versus abdominal hysterectomy. Am J Obstet Gynecol. 1997;34(5): 543
[7] 黎培毅,夏恩兰整理.全国妇产科内镜应用学术研讨会纪要.中华妇产科杂志.1999;32(5):263
[8] 张建萍,卢丹,王维,等.妇产科腹腔镜术与剖腹手术对机体应激反应的比较研究.中国实用妇科与产科杂志.2000;16(10):615
[9] 张建萍,卢丹,姜淑清,等.腹腔镜手术在妇科的临床应用价值.实用妇产科杂志.2001,;17(2):100
[10] Otosen C. Lingman G. Three methods for hysterectomy: a randomized, prospective study of short tern outcome. Br J Obstet Gynaecol. 2000;107: 1380-1385
[11] Ellstrom M, Ferraz-Nunes J, Hahlin M, et al. A randomized trial with a cost-consequence analysis after laparoscopic and abdominal hysterectomy. Obstet Gynecol. 1998;91: 30-34
[12] 姚书忠.腹腔镜子宫切除术.实用妇产科杂志.2002:18:72-74
[13] Carlson KJ. Outcomes of hysterectomy. Clin obstet&gynecol, 1997;40: 939-946
[14] 万崇华.生命质量测定与评价方法.昆明:云南大学出版社(第一版)。1999:107-112
[15] 李鲁,王红妹,沈毅.SF-36健康调查量表中文版的研制及其性能测试.中华预防医学杂志.2002:36(2):109-113
[16] Ware JE, Sherboume CD. The MOS 36-item short-form health survey (SF-36): Conceptual framework and item selection. Med Care. 1992, 30(6): 473-483
[17] 方积乾 主编.生存质量测定方法及应用.北京:北京医科大学出版社(第一版).2000:114
[18] 蓝宜,李天霖,王滨燕.生存质量——一种多维的健康评价方法.国外医学社会医学分册.1996;13(3):118-120
[19] Perneger TV, Leplege A, Etter JF, et al. Validation of a French-language version of the MOS 36-item short form health survey (SF-36) in young healthy adults. J Clin Epidemiol. 1995;48(8): 1051-1060
[20] Bullinger M. German translation and psychometric testing of the SF-36 health Survey: preliminary results from the IQOLA project. International Quality of Life Assessment. Soc Sci Med. 1995;41(10): 1359-1366
[21] Osborne HR, Hawthorne G, Lew EA, et al. Quality of life assessment in the commutity-dwelling elderly: Validation of the Assessment of Quality of Life(AQoL) Instrumen and comparison with the SF-36. J Clin Epidemiol. 2003;56(2): 138-147
[22] Heffernan N, Celia D, Webster K, et al. Measuring health-related quality of life in patients with hepatobiliary cancers: The functional assessment of cancer therapy-hepatobiliaryquestionnaire. J Clin Oncol. 2002;20(9): 2229-2239
[23] Li lu, Jiang minmin. Tests of reliability, validity and responsiveness of the SF-36 scales in hemodialy sis patients. Clin Med J. 2002;115(6): 995-997
[24] 任晓辉,刘朝杰,李宁秀等.SF-36量表评价慢性病患者的生命质量.华西医大学报.2001;32(2):250-253
[25] hubetkin EI, Jia H, Gold MR. Use of the SF-36 in low-income Chinese American primary care patients. Med Care. 2003;41(4): 447-457
[26] 张磊,邵晨,王波,等.中文版SF-36量表用于中国老年军人生存质量调查的信度与效度评价.中华老年医学杂志.2004;23(2):112-114
[27] Nero JFR, Fenz MB, CenderogloM, et al. Quality of life at the initiation maintenance dialysis treatment: A comparison between SF-36 and KDQ questionnaire. Qual Life Res. 2000;9101-107
[28] 王红妹,李鲁,沈毅.中文版SF-36量表用于杭州市区居民生命质量研究.中华预防医学杂志.2001;35(6):428-430
[29] 汤旦林,王松柏.生存质量测定及其在临床实验中应用.中华医学杂志.1994;74(3):175-179
[30] 方积乾,郑元涛,李彩霞,等.世界卫生组织生活质量量表中文版的信度和效度.中国心理卫生杂志.1999;13(4):203-205
[31] 刘朝杰,李宁秀,任晓晖,等.36条简明量表在中国人群中的适用性研究.华西医大学报.2001;32(1)39-42
[32] Rock JA. Quality-of-life assessment in gynecologic surgery. J Reprod Med. 2001;46(5 Suppl): 515-9
[33] Carlson KJ, Miller BA, Fowler FJ. The Maine Women's Health Study: outcomes of hysterectomy. Obstet Gynecol. 1994;83: 556-565
[34] Schofield MJ, Bennet A, Redman S, et al. Self-reported long-term outcomes of hysterectomy. Br J Obstet Gynaecol. 1991;98: 1129-1136
[35] Kjedilf KH, Langenberg PW, Rhodes JC. Efectiveness of hysterectomy. Obstet Gynecol. 2000;95: 319-326
[36] Michelle JN, Wendy LM. Health-related quality of life after hysterectomy. Clin Obstet and Gyn. 1997;40(4): 947-957
[37] Julia CR, Kristen H, et al. Hysterectomy and sexual functioning. JAMA. 1999:282:1934-1941
[38]Rannestad T, Eikeland 0, Helland, et al. The quality of life in women suffering from gynecological disorders is improved by means of hysterec -tomy. Absolute and relative diferences between pre-and postoperative measures. Acta Obstet Gynecol Scand. 2001;80(1):46-51
[39]Jambden MP, Bellamy G, Ogbum-Russel J,et al. Women's sense of well -being before and after hysterectomy. J Obstet Gynecol Neonatal Nuts. 1997;26(5):540-8
[40]Garry R. The future of hysterectomy. BJOG. 2005;112(2):133-9
[41] Joanne E, Davies, Doyle PM. Quality of life in unselected gynecological outpatients and inpatients before and after hysterectomy. J Obstet and Gyn. 2002;22 (5):523-526
[2] Wilcox LS, Koonin LM, Pokras R, et al, Hysterectomy in the united states, 1988-1990. Obstet Gynecol. 1994;83: 549-555
[3] Marana R, Busacca M, Zupi E, et al. Laparoscopiciiy assiasted vaginal hysterectomy versus total abdominal hysterectomy: a prospective, randomized, multi-center study. Am J Obstet Gynecol. 1999;180: 270-275
[4] Meeks GR, Harris RL. Surgical approach to hysterectomy: Abdominal, laparoscopy asissted, or vaginal. Clin Obstet and Gyn. 1997;40: 886-894
[5] Reich H, et al. Laparoscopic hysterectomy. J Gynecol Surg, 1989;5: 213-21
[6] Labib M, Palfrey S, Paniagua E, et al. The postoperative inflammatory responses to injury following laparoscopiclly assisted vaginal hysterectomy versus abdominal hysterectomy. Am J Obstet Gynecol. 1997;34(5): 543
[7] 黎培毅,夏恩兰整理.全国妇产科内镜应用学术研讨会纪要.中华妇产科杂志.1999;32(5):263
[8] 张建萍,卢丹,王维,等.妇产科腹腔镜术与剖腹手术对机体应激反应的比较研究.中国实用妇科与产科杂志.2000;16(10):615
[9] 张建萍,卢丹,姜淑清,等.腹腔镜手术在妇科的临床应用价值.实用妇产科杂志.2001,;17(2):100
[10] Otosen C. Lingman G. Three methods for hysterectomy: a randomized, prospective study of short tern outcome. Br J Obstet Gynaecol. 2000;107: 1380-1385
[11] Ellstrom M, Ferraz-Nunes J, Hahlin M, et al. A randomized trial with a cost-consequence analysis after laparoscopic and abdominal hysterectomy. Obstet Gynecol. 1998;91: 30-34
[12] 姚书忠.腹腔镜子宫切除术.实用妇产科杂志.2002:18:72-74
[13] Carlson KJ. Outcomes of hysterectomy. Clin obstet&gynecol, 1997;40: 939-946
[14] 万崇华.生命质量测定与评价方法.昆明:云南大学出版社(第一版)。1999:107-112
[15] 李鲁,王红妹,沈毅.SF-36健康调查量表中文版的研制及其性能测试.中华预防医学杂志.2002:36(2):109-113
[16] Ware JE, Sherboume CD. The MOS 36-item short-form health survey (SF-36): Conceptual framework and item selection. Med Care. 1992, 30(6): 473-483
[17] 方积乾 主编.生存质量测定方法及应用.北京:北京医科大学出版社(第一版).2000:114
[18] 蓝宜,李天霖,王滨燕.生存质量——一种多维的健康评价方法.国外医学社会医学分册.1996;13(3):118-120
[19] Perneger TV, Leplege A, Etter JF, et al. Validation of a French-language version of the MOS 36-item short form health survey (SF-36) in young healthy adults. J Clin Epidemiol. 1995;48(8): 1051-1060
[20] Bullinger M. German translation and psychometric testing of the SF-36 health Survey: preliminary results from the IQOLA project. International Quality of Life Assessment. Soc Sci Med. 1995;41(10): 1359-1366
[21] Osborne HR, Hawthorne G, Lew EA, et al. Quality of life assessment in the commutity-dwelling elderly: Validation of the Assessment of Quality of Life(AQoL) Instrumen and comparison with the SF-36. J Clin Epidemiol. 2003;56(2): 138-147
[22] Heffernan N, Celia D, Webster K, et al. Measuring health-related quality of life in patients with hepatobiliary cancers: The functional assessment of cancer therapy-hepatobiliaryquestionnaire. J Clin Oncol. 2002;20(9): 2229-2239
[23] Li lu, Jiang minmin. Tests of reliability, validity and responsiveness of the SF-36 scales in hemodialy sis patients. Clin Med J. 2002;115(6): 995-997
[24] 任晓辉,刘朝杰,李宁秀等.SF-36量表评价慢性病患者的生命质量.华西医大学报.2001;32(2):250-253
[25] hubetkin EI, Jia H, Gold MR. Use of the SF-36 in low-income Chinese American primary care patients. Med Care. 2003;41(4): 447-457
[26] 张磊,邵晨,王波,等.中文版SF-36量表用于中国老年军人生存质量调查的信度与效度评价.中华老年医学杂志.2004;23(2):112-114
[27] Nero JFR, Fenz MB, CenderogloM, et al. Quality of life at the initiation maintenance dialysis treatment: A comparison between SF-36 and KDQ questionnaire. Qual Life Res. 2000;9101-107
[28] 王红妹,李鲁,沈毅.中文版SF-36量表用于杭州市区居民生命质量研究.中华预防医学杂志.2001;35(6):428-430
[29] 汤旦林,王松柏.生存质量测定及其在临床实验中应用.中华医学杂志.1994;74(3):175-179
[30] 方积乾,郑元涛,李彩霞,等.世界卫生组织生活质量量表中文版的信度和效度.中国心理卫生杂志.1999;13(4):203-205
[31] 刘朝杰,李宁秀,任晓晖,等.36条简明量表在中国人群中的适用性研究.华西医大学报.2001;32(1)39-42
[32] Rock JA. Quality-of-life assessment in gynecologic surgery. J Reprod Med. 2001;46(5 Suppl): 515-9
[33] Carlson KJ, Miller BA, Fowler FJ. The Maine Women's Health Study: outcomes of hysterectomy. Obstet Gynecol. 1994;83: 556-565
[34] Schofield MJ, Bennet A, Redman S, et al. Self-reported long-term outcomes of hysterectomy. Br J Obstet Gynaecol. 1991;98: 1129-1136
[35] Kjedilf KH, Langenberg PW, Rhodes JC. Efectiveness of hysterectomy. Obstet Gynecol. 2000;95: 319-326
[36] Michelle JN, Wendy LM. Health-related quality of life after hysterectomy. Clin Obstet and Gyn. 1997;40(4): 947-957
[37] Julia CR, Kristen H, et al. Hysterectomy and sexual functioning. JAMA. 1999:282:1934-1941
[38]Rannestad T, Eikeland 0, Helland, et al. The quality of life in women suffering from gynecological disorders is improved by means of hysterec -tomy. Absolute and relative diferences between pre-and postoperative measures. Acta Obstet Gynecol Scand. 2001;80(1):46-51
[39]Jambden MP, Bellamy G, Ogbum-Russel J,et al. Women's sense of well -being before and after hysterectomy. J Obstet Gynecol Neonatal Nuts. 1997;26(5):540-8
[40]Garry R. The future of hysterectomy. BJOG. 2005;112(2):133-9
[41] Joanne E, Davies, Doyle PM. Quality of life in unselected gynecological outpatients and inpatients before and after hysterectomy. J Obstet and Gyn. 2002;22 (5):523-526