3种方法修复口腔及口咽癌术后缺损1年后生存质量分析

目的：分析3种修复方式(拉拢缝合、颏下岛状皮瓣、前臂皮瓣)修复口腔及口咽癌患者术后缺损1年后的生存质量及相关影响因素。方法对 2012年1月—2012年10月在中山大学孙逸仙纪念医院口腔颌面外科行口腔及口咽癌术后1年的47例患者进行问卷调查。采用华盛顿大学生存质量问卷第4版及欧洲癌症研究与治疗组织生存质量问卷第3版、头颈问卷第1版。将伤口直接缝合、颏下岛状瓣、前臂皮瓣修复口腔及口咽癌术后缺损分为3组后,分析不同修复方式对患者术后1年生存质量的影响。采用SPSS 20.0软件包对数据进行统计学分析。结果47例患者完成相关问卷。前臂皮瓣组在吞咽、咀嚼、语言和UW-QOL整体项中显著优于直接拉拢缝合组（P<0.05）,在UW-QOL问卷中的总分也好于后者（P<0.05）,与颏下瓣组相比,2组患者的总体生存质量无显著差异（P>0.05）;颏下瓣组在咀嚼、语言和食欲丧失项中显著好于直接拉拢缝合组（P<0.05）。结论口腔及口咽癌术后1年患者中,吞咽、语言和咀嚼成为近期患者生存质量的主要方面,术后应加强对患者进行语言和吞咽等训练。术中同期对口腔及口咽癌进行皮瓣修复,可以显著提高患者的生存质量。

Analysis of quality of life for oral and oropharyngeal cancer patients using three methods for reconstruction of defects at one year after surgery

PURPOSE:The aim of this study was to evaluate quality of life of oral and oropharyngeal cancer patients who underwent reconstruction with three methods. METHODS: Forty-seven patients with oral and oropharyngeal squamous cell carcinoma who underwent primary surgery in Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2012 to October 2012 were recruited. University of Washington Quality of Life Questionnaire version 4 (UW- QOL V4), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire version 3(EORTC QLQ-C30 v3) and Head and Neck version 1(EORTC H&N35 v1) were used as questionnaires for this study.The patients were divided into primary closure, submental island pedicled flap (SIPF), radial forearm free flap (RFFF) group according to reconstruction techniques. Statistical analysis was conducted using SPSS 20.0 software package. RESULTS: Forty-seven patients completed the questionnaires. Patients who underwent RFFF had higher QOL in swallowing, chewing and speech and overall score compared with primary closure group (P<0.05). There was no significant difference (P>0.05) between RFFF and SIPF groups in overall QOL one year after surgery. Furthermore, the QOL of SIPF group was better than primary closure group in chewing, speech and appetite loss. CONCLUSIONS: Swallowing, chewing and speech were major factors that affect recent QOL of oral and oropharyngeal cancer patients one year after surgery. Training of speech and swallowing should be addressed for postoperative patients.