Schmidt-Matthiesen A, Weidmann R, Sänger P
Klinik für Allgemein- und Gefässchirurgie, Klinikum der Johann Wolfgang Goethe-Universität.
Zentralbl Chir. 2003 Apr;128(4):304-8. doi: 10.1055/s-2003-38794.
This prospective longitudinal study on gastric carcinoma patients with gastrectomy was designed to answer the question about changes in several determinants of the quality of life (QL) at various times before and after surgery and to obtain evidence for specific approaches of therapeutic intervention.
36 patients were given a questionnaire structured according to Eypasch et al. (self- assessment) before surgery, at discharge from the hospital, and after 3 and 6 months. The dual structure of the questions makes it possible to determine whether a single item is present at all (prevalence) and to what extent it impairs the quality of life (no impairment/some/moderate/strong impairment--corresponding to 0-3). The data were evaluated per domain of QL as well as item-related.
Postoperatively, 14 patients had to be excluded from the study because of non-radical surgery, complications, recurrences, etc. After 6 months the items of all QL-determinants showed the lowest prevalence with the exception, however, of the somatic determinants, the items of which showed a prevalence of 27 % preoperatively, 64 % at discharge from the hospital, 58 % after 3 months, and 46 % after 6 months. The average degree of QL-impairment increased continuously from 1.17 preoperatively to 1.61 after 6 months. Preoperatively the psychic domain was predominantly impaired, postoperatively the somatic domain.
Analysis of the subjective quality of life can reveal care deficits. Gastrectomy-associated symptoms seem to influence the quality of life considerably in the first 6 months after surgery. More attention has to be paid to the sequelae of surgery. The high pre- and postoperative frequency of psychic impairment makes it desirable to provide special psychooncological offers of care.
这项针对接受胃切除术的胃癌患者的前瞻性纵向研究旨在回答关于手术前后不同时间点生活质量（QL）的几个决定因素变化的问题，并为治疗干预的具体方法获取证据。
36例患者在手术前、出院时以及术后3个月和6个月接受了根据艾帕斯奇等人（自我评估）构建的问卷。问题的双重结构使得可以确定单个项目是否存在（患病率）以及它在多大程度上损害生活质量（无损害/轻度/中度/重度损害——对应于0 - 3）。数据按QL的每个领域以及与项目相关进行评估。
术后，14例患者因非根治性手术、并发症、复发等原因被排除在研究之外。6个月后，所有QL决定因素的项目患病率最低，但躯体决定因素除外，其项目术前患病率为27%，出院时为64%，3个月后为58%，6个月后为46%。QL损害的平均程度从术前的1.17持续增加到6个月后的1.61。术前主要是心理领域受损，术后是躯体领域受损。
对主观生活质量的分析可以揭示护理缺陷。胃切除相关症状在术后头6个月似乎对生活质量有相当大的影响。必须更加关注手术后遗症。心理损害术前和术后的高发生率使得提供特殊的心理肿瘤护理服务成为必要。
