目的探讨头颈肿瘤及外科治疗对患者生存质量(quality of life ,QOL)的影响.方法用头颈肿瘤行为状态量表(performance status scale for head and neck cancer patients,PSS-HN),癌症治疗功能评估调查问卷(functional assessment of cancer therapy-head and neck,FACT-H&N),对27例喉癌、14例舌癌和8例放疗后局部复发的鼻咽癌患者,共49例病例进行评估,探讨不同部位的肿瘤对患者QOL的影响;肿瘤对患者生理状况、功能状况、情感状况、社会和家庭状况的影响;不同的外科治疗方式对QOL的影响以及QOL在手术治疗前后不同时间点的变化.结果头颈肿瘤患者在患病后QOL下降;不同部位的肿瘤对患者QOL的影响程度不同,以舌癌对患者的QOL影响最大(PSS-HN评分比较 P=0.0361, FACT-H&N评分比较P=0.0487).肿瘤对患者的生理状况、功能状况、情感状况、社会和家庭状况等各个方面均有影响,尤以对情感状况影响最大(FACT-H&N评分比较 F=2.78, P=0.0311).外科治疗可使患者的QOL较手术前下降,术后可随时间而逐步改善,术后6个月接近术前水平(PSS-HN评分比较 t=2.03, P=0.1120; FACT-H&N评分比较 t=1.03, P=0.1180).不同的手术方式与修复手段对QOL的影响不同,喉部分切除术组在术后6个月FACT-H&N为107.20分,喉全切除术组在手术后6个月为97.71分,二者的差异有统计学意义(t=3.02,P=0.0430).舌癌直接拉拢缝合组在术后6个月FACT-H&N为119.24分,舌癌游离前臂皮瓣修复者在术后6个月为111.39分,其差异有统计学意义(t=3.00,P=0.0472). 结论头颈肿瘤患者的QOL可以用问卷、量表进行评估;可以通过治疗方案的选择、手术方式与修复手段的选择进行干预.
ObjectiveTo evaluate head and neck cancer and surgical treatment impact the quality of life （QOL）. MethodsIn this study , 49 cases of head and neck cancer patients were recruited. Among them, 27 cases were laryngeal cancer, 14 cases were tongue cancer and 8 patients were recurrence of nasal pharyngeal cancer after radical radiotherapy. To demonstrate the cancer in different sites of the head and neck impact QOL of the patients in a different way and cancer impact QOL on the physical well-being, social family well-being, emotional well-being, functional well-being of the patients and quality of life （QOL）changed in different time-point before and after operation, QOL was assessed before surgical treatment and at 1,6 months after operation by means of a performance status scale for head and neck cancer patients （PSS-HN） and the functional assessment of cancer therapy head and neck （FACT-H＆N） questionnaire. ResultsQOL deterioratedsiguificantly in head and neck cancer patients. Cancer in different sites impact on QOL differently especially in patients with tongue cancer （PSS-HN P = 0.0361, FACT-H＆N P = 0.0487）. Head and neck cancer impact QOL on the physical well-being , social family well-being, emotional well-being,functional well-being of the patients in FACT-H＆N questionnaire especially for emotional well-being domains（F = 2.78, P = 0.0311）. The QOL in patients deteriorated by surgical treatment and it could be improved following the time. At the 6 months after operation it nearly reached the same scores that assessed before the operation （PSS-HN t = 2.03, P = 0.1120 FACT-H＆N t = 1.03, P = 0.1180）. Different surgical approaches and different reconstruction methods have different impact on QOL for patients. Laryngeal cancer patients with partial laryngectomy were 107.20 in FACT-H＆N while total laryngectomees were 97.71 at the 6 months after operation, with statistically difference （ t = 3.02, P = 0. 0430 ） . Tongue cancer patients without reconstruction were ll9. 24 in FACT-H＆N while the others with reconstruction were ll 1.39 at the 6 months after operation（ t = 3.00, P = 0. 0472）. ConclusionsThe QOL in head and neck cancer patients can be assessed by the questionnaire and it can be improved by selecting treatment regimen, surgical approaches and reconstructive methods.
边学,徐震纲,吕春梅,等. 头颈肿瘤与外科治疗对患者生存质量的影响 : [J]. 中华耳鼻咽喉头颈外科杂志,2005,40(08)：606-610.
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