子宫肌瘤治疗方法及效果的生活质量评估。
Quality-of-life assessment of fibroid treatment options and outcomes.
机构信息
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
出版信息
Radiology. 2011 Jun;259(3):785-92. doi: 10.1148/radiol.11100704. Epub 2011 Mar 1.
PURPOSE
To obtain utilities (a unit of measure of a person's relative preferences for different health states compared with death or worst possible outcome) for uterine fibroids before and after treatment and to measure short-term utilities for the following uterine fibroid treatments: abdominal hysterectomy, magnetic resonance (MR) imaging-guided focused ultrasound surgery, and uterine artery embolization (UAE).
MATERIALS AND METHODS
This retrospective study was approved by the institutional review board and was HIPAA compliant. The waiting trade-off (WTO) method, a variation on the time trade-off (TTO) method, is used to obtain utilities for diagnostic procedures on the basis of the fact that people wait longer to avoid noxious tests and/or procedures. The WTO method provides short-term quality of life tolls in terms of quality-adjusted life-weeks by scaling wait times with pre- and posttreatment utilities. Utilities for uterine fibroids before and after treatment were obtained with the TTO method and a visual analog scale (VAS) by using a questionnaire administered by means of a phone interview. WTO wait times were adjusted for quality of life with VAS and TTO utilities and a transformation of VAS. Wait times were compared by using nonparametric tests. The study participants included 62 patients who had undergone abdominal hysterectomy, 74 who had undergone UAE, and 61 who had undergone MR imaging-guided focused ultrasound surgery.
RESULTS
Quality of life increased with all treatments. The median WTO wait time was higher for hysterectomy (21.6 weeks) than for UAE or MR imaging-guided focused ultrasound surgery (14.1 weeks for both) (P < .05). Quality-adjusted life-week tolls were smaller when scaled according to TTO than when scaled according to VAS or transformation of VAS.
CONCLUSION
Quality of life increased after all fibroid treatments. WTO is feasible for assessing the quality-adjusted morbidity of treatment procedures.
SUPPLEMENTAL MATERIAL
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11100704/-/DC1.
目的
获得治疗前后子宫纤维瘤的效用（一种与死亡或最差可能结果相比，个体对不同健康状态的相对偏好的衡量单位），并衡量以下子宫纤维瘤治疗方法的短期效用：腹式子宫切除术、磁共振（MR）成像引导聚焦超声手术和子宫动脉栓塞术（UAE）。
材料与方法
本回顾性研究经机构审查委员会批准并符合 HIPAA 规定。等待权衡（WTO）方法是时间权衡（TTO）方法的一种变体，用于根据人们为避免有害测试和/或程序而等待更长时间的事实，为诊断程序获得效用。WTO 方法通过用治疗前后的效用来缩放等待时间，从而以调整后的生命周数为单位提供短期生活质量代价。通过电话访谈进行问卷调查，使用 TTO 方法和视觉模拟量表（VAS）获得治疗前后子宫纤维瘤的效用。WTO 等待时间通过 VAS 和 TTO 效用以及 VAS 的转换进行生活质量调整。使用非参数检验比较等待时间。研究参与者包括 62 例行腹式子宫切除术、74 例行 UAE 和 61 例行 MR 成像引导聚焦超声手术的患者。
结果
所有治疗均能提高生活质量。子宫切除术的中位 WTO 等待时间（21.6 周）高于 UAE 或 MR 成像引导聚焦超声手术（两者均为 14.1 周）（P <.05）。根据 TTO 进行缩放的质量调整生命周数代价小于根据 VAS 或 VAS 转换进行缩放的代价。
结论
所有纤维瘤治疗后生活质量均提高。WTO 可用于评估治疗程序的质量调整发病率。
补充材料
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11100704/-/DC1.
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