手术方式对乳腺癌患者不同阶段生活质量的影响

背景与目的：随着医学模式的转变，肿瘤患者术后生活质量(quality of life)已成为评价整体治疗的重要标准之一。本研究旨在探讨不同手术方式对乳腺癌患者治疗和康复各阶段的生活质量的影响。方法：对2012年4月—2013年4月在北京同仁医院肿瘤中心手术后复查以及首次接受手术的乳腺癌患者共207例进行生活质量评定，其中保留乳房的乳腺癌切除术61例，全乳切除即刻乳房重建术60例，乳腺癌改良根治术86例，通过配对设计方法，使用量表进行调查，并进行统计学分析。结果：围手术期时，接受保乳手术或全乳切除即刻乳房重建手术的患者与接受改良根治术的患者主要在生理、情感和焦虑、抑郁等不良情绪水平方面差异有统计学意义(P<0.05)，而在生活质量方面差异无统计学意义(P>0.05)；术后2年和术后5年，接受保乳手术或全乳切除即刻乳房重建手术的患者与接受改良根治术的患者在生活质量方面差异有统计学意义(P<0.05)，而在生理、情感和焦虑、抑郁等不良情绪水平方面差异无统计学意义(P>0.05)。结论：保留乳房的乳腺癌切除术和全乳切除即刻乳房重建手术较乳腺癌改良根治术可明显降低乳腺癌患者在围手术期焦虑、抑郁等不良情绪，并可不同程度提高患者的远期生活质量。

Influences on quality of life of patients with breast cancer in different stages undergone different styles of operations

Background and purpose: This study aimed to explore the influences on quality of life of patients with breast cancer in different stages undergone different styles of operations. Methods: During Apr. 2012 and Apr. 2013, a total number of 207 patients with breast cancer, including 61 patients undergone breast conserving surgery (BCS), 60 patients undergone immediate breast reconstruction (IBR) and 86 patients undergone modified radical mastectomy (MRM) reviewed or admitted in Beijing Tongren Hospital Affiliated to Capital Medical University were included in the research, in which FACT-B, SAS and SDS were used to assess the quality of life and negative emotions performing as the paired design. Results: The physical well-being, emotional well-being and the level of negative emotions such as anxiety and depression revealed significant differences compared the patients who undergone BCS or IBR with those who undergone MRM in preoperative period (P<0.05), and there was no statistical difference in terms of other quality of life (P>0.05). At two and five years postoperatively, there was no significant in the physical well-being, emotional well-being and negative emotions (P>0.05), whereas there was significant differences in the other quality of life (P<0.05). Conclusion: BCS and IBR compared with MRM can obviously reduce the levels of preoperative negative emotions such as anxiety and depression, and improve the quality of life in long-term (two and five years postoperatively) to some degree.