45-50歲子宮肌瘤患者腹腔鏡下不同術(shù)式生活質(zhì)量調(diào)查及衛(wèi)生經(jīng)濟(jì)學(xué)分析
發(fā)布時(shí)間：2019-07-05 14:48
【摘要】：研究背景： 子宮肌瘤是女性生殖器官最常見的良性腫瘤，發(fā)生率20—30%，多見于30—50歲女性。子宮肌瘤可采用手術(shù)療法和非手術(shù)療法，但迄今尚未發(fā)現(xiàn)療效確切、可有效避免或控制復(fù)發(fā)的非手術(shù)療法，因此手術(shù)療法仍是當(dāng)前子宮肌瘤患者的最常用的治療措施。腹腔鏡現(xiàn)已成為婦科手術(shù)主要的途徑。腹腔鏡手術(shù)治療子宮肌瘤可選擇肌瘤剔除術(shù)和子宮切除術(shù)，既往45歲以上的子宮肌瘤患者多采用子宮切除術(shù)，在去除原發(fā)病的同時(shí)杜絕了子宮病變的發(fā)生，隨著宮頸疾病篩查的普及、宮腔鏡子宮內(nèi)膜病變的檢查和治療，子宮病變能夠早期發(fā)現(xiàn)和治療。隨著生活水平的提高，對(duì)生活質(zhì)量的要求也更高了，越來越多的人重視子宮的去留問題，絕經(jīng)過渡期或絕經(jīng)期患者亦希望保留子宮。采取何種手術(shù)方式是醫(yī)患雙方共同關(guān)注的問題。尤其對(duì)于已經(jīng)完成生育的絕經(jīng)過渡期子宮肌瘤患者，，究竟選擇何種術(shù)式更符合患者的生理和心理要求尚無定論。對(duì)絕經(jīng)過渡期女性不同術(shù)式術(shù)后生活質(zhì)量的關(guān)注及調(diào)查目前尚缺乏。注重生活質(zhì)量的提高，更能體現(xiàn)以人為本的醫(yī)學(xué)理念。對(duì)患者進(jìn)行生活質(zhì)量的調(diào)查評(píng)價(jià)和不同術(shù)式衛(wèi)生經(jīng)濟(jì)學(xué)評(píng)價(jià)，是了解患者疾病負(fù)擔(dān)和評(píng)估療效的新方法。 研究目的： 通過對(duì)45-50歲子宮肌瘤患者手術(shù)治療前后進(jìn)行SF-36生活質(zhì)量問卷調(diào)查及絕經(jīng)過渡期癥狀和性生活質(zhì)量研究，了解腹腔鏡子宮肌瘤剔除術(shù)和腹腔鏡全子宮切除術(shù)這兩種術(shù)式對(duì)絕經(jīng)過渡期子宮肌瘤患者術(shù)后生活質(zhì)量的影響、分析其可能原因，并對(duì)兩種手術(shù)的費(fèi)用和住院時(shí)間進(jìn)行比較和衛(wèi)生經(jīng)濟(jì)學(xué)評(píng)價(jià)，從而在選擇術(shù)式及預(yù)測(cè)術(shù)后生活質(zhì)量方面給與指導(dǎo)，探索出一條針對(duì)絕經(jīng)過渡期子宮肌瘤患者科學(xué)、行之有效的手術(shù)方法，使生理-心理-社會(huì)醫(yī)學(xué)模式在婦科臨床中得到推廣應(yīng)用。 研究對(duì)象： 選取2013.1.1--2013.7.31因子宮肌瘤于大連市婦產(chǎn)醫(yī)院住院行腹腔鏡手術(shù)治療的患者。年齡45—50周歲，月經(jīng)規(guī)律，超聲提示肌瘤≤5枚，做病情溝通后根據(jù)個(gè)人意愿選擇肌瘤剔除術(shù)或全子宮切除術(shù)。術(shù)前三個(gè)月內(nèi)未應(yīng)用激素相關(guān)治療，術(shù)前診刮除外內(nèi)膜病變，術(shù)后病理證實(shí)為子宮平滑肌瘤。行腹腔鏡子宮肌瘤剔除術(shù)患者30例，，腹腔鏡全子宮切除術(shù)患者30例。 研究方法： 主問卷為SF-36測(cè)量表，輔助問卷為絕經(jīng)過渡期癥狀調(diào)查表和性生活調(diào)查表，統(tǒng)計(jì)患者住院時(shí)間和花費(fèi)。所有患者入院后手術(shù)前及術(shù)后6月填寫，回收問卷，對(duì)施行不同手術(shù)的患者術(shù)后生活質(zhì)量進(jìn)行評(píng)價(jià)。問卷評(píng)分遵循其系統(tǒng)計(jì)分方法。數(shù)據(jù)統(tǒng)計(jì)學(xué)分析采用SPSS13.0軟件包。統(tǒng)計(jì)學(xué)方法采用t檢驗(yàn)或卡方檢驗(yàn)，信度效度分析。P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 1、SF-36生活質(zhì)量測(cè)量量表應(yīng)用于子宮肌瘤患者并對(duì)其進(jìn)行生活質(zhì)量的評(píng)價(jià)具有可行性，效果良好。 2、SF-36總分兩組患者術(shù)前比較無差異（p0.05），腹腔鏡子宮肌瘤剔除組術(shù)后SF-36評(píng)分高于術(shù)前（p0.05），而腹腔鏡全子宮切除組術(shù)后評(píng)分低于術(shù)前（p0.05），術(shù)后腹腔鏡子宮肌瘤剔除組的總分明顯高于腹腔鏡全子宮切除組（p0.05）。 3、SF-36各維度評(píng)分兩組術(shù)前比較無差異（p0.05),腹腔鏡子宮肌瘤剔除組術(shù)后軀體職能、一般健康感、社交功能、情感職能和精神健康5個(gè)維度評(píng)分高于術(shù)前（p0.05），腹腔鏡全子宮切除組術(shù)后軀體機(jī)能、軀體職能、一般健康感、社交功能、情感職能和精神健康6個(gè)維度評(píng)分均低于術(shù)前，且低于腹腔鏡子宮肌瘤剔除組（p0.05）。 4、絕經(jīng)過渡期癥狀發(fā)生率兩組術(shù)前比較無差異（p0.05),腹腔鏡全子宮切除術(shù)患者術(shù)后6月潮熱、焦慮/憂郁和疲勞乏力的絕經(jīng)過渡期癥狀發(fā)生率高于腹腔鏡子宮肌瘤剔除術(shù)患者（p0.05）。 5、性生活質(zhì)量?jī)山M術(shù)前比較無差異（p0.05)，腹腔鏡子宮肌瘤剔除組術(shù)后性生活質(zhì)量與術(shù)前比較無差異（p0.05)，但腹腔鏡全子宮切除組手術(shù)后性欲降低、陰道干燥和性焦慮的發(fā)生率高于術(shù)前，且高于腹腔鏡子宮肌瘤剔除組（p0.05)。 6、腹腔鏡子宮肌瘤剔除組的平均住院時(shí)間、平均術(shù)后住院時(shí)間、手術(shù)費(fèi)和藥費(fèi)低于腹腔鏡全子宮切除組（p0.05）。 結(jié)論： 對(duì)于45-50歲子宮肌瘤患者： 1、SF-36生活質(zhì)量測(cè)量量表可以應(yīng)用于子宮肌瘤患者生活質(zhì)量的測(cè)量及評(píng)價(jià)，具有良好的性能。 2、腹腔鏡子宮肌瘤剃除術(shù)患者術(shù)后6月的總體生活質(zhì)量高于采用腹腔鏡全子宮切除術(shù)患者。 3、腹腔鏡子宮肌瘤剔除術(shù)提高了術(shù)后患者的生活質(zhì)量，而腹腔鏡全子宮切除術(shù)后患者的生活質(zhì)量降低，患者的生理健康和心理健康均受影響。 4、腹腔鏡全子宮切除組患者術(shù)后6月絕經(jīng)過渡期癥狀發(fā)生率高于腹腔鏡子宮肌瘤剔除術(shù)患者。 5、腹腔鏡子宮肌瘤剔除術(shù)對(duì)患者術(shù)后性生活質(zhì)量無不良影響，腹腔鏡全子宮切除術(shù)患者術(shù)后性生活質(zhì)量低于術(shù)前，并低于腹腔鏡子宮肌瘤剔除術(shù)后患者。 6、腹腔鏡子宮肌瘤剔除術(shù)的住院時(shí)間和醫(yī)療花費(fèi)均低于腹腔鏡全子宮切除術(shù)。 7、腹腔鏡子宮肌瘤剔除術(shù)患者較腹腔鏡全子宮切除術(shù)患者術(shù)后有更高的生活質(zhì)量，對(duì)絕經(jīng)過渡期和性生活質(zhì)量的影響小，經(jīng)濟(jì)花費(fèi)少，值得臨床推廣。
[Abstract]:Study Background: Hysteromyoma is the most common benign tumor of female reproductive organs, with a rate of 20% and 30%, which is found in 30-50-year-old women. Sex. Hysteromyoma can be used for surgical and non-operative treatment, but so far, it has not been found that the curative effect is definite, can effectively avoid or control the non-operative treatment of the recurrence, so the operation therapy is still the most commonly used treatment measure in the patients with the current uterine fibroids. Application. The laparoscope has now become the main course of the gynecological operation. diameter. The laparoscopic operation for the treatment of hysteromyoma can be used for the selection of myomectomy and hysterectomy, and a hysterectomy is used in the patients with the uterine fibroids with the previous 45-year-old, and the occurrence of the uterine lesion is eliminated while the original disease is removed, and as the screening of the cervical diseases And the detection and treatment of the endometrial lesions of the hysteroscope, which can be found and treated in an early stage. With the improvement of the living standard, the demand for quality of life is also higher, and more and more people pay more attention to the problem of the retention of the uterus. The way of operation is the question of mutual interest between the doctor-patient and the doctor-patient In particular, in the case of postmenopausal women with uterine fibroids who have completed the birth, the choice of surgical procedure is more consistent with the physiological and psychological requirements of the patient. A Study on the Quality of Life of Postmenopausal Women with Different Methods of Operation and Investigation Spent. Pay attention to the improvement of the quality of life, and more embody the people-oriented medical science. The investigation and evaluation of the quality of life of the patient and the evaluation of the health economics of different operation procedures are the new prescription for understanding the burden of the disease and evaluating the curative effect of the patients. A. Research Objective: To investigate the quality of life quality of SF-36 before and after the operation of 45-50-year-old patients with hysteromyoma and the symptoms and sex of post-menopausal transition. To study the effect of laparoscopic myomectomy and laparoscopic total hysterectomy on the quality of life in the post-menopausal women with uterine fibroids. Economic evaluation, so as to provide guidance on the choice of operation and the quality of life after operation, and to explore a scientific and effective operation method for the patients with uterine fibroids in the transition period, and make the physiological-psychological-social medical pattern in the clinical of the gynaecology. to popularization and application . Study object: select 2013.1.1--2013.7.31 to be hospitalized for uterine fibroids in the hospital of Dalian Maternity Hospital The patients with endoscopic surgical treatment. The age of 45 to 50 years of age, the rule of menstruation, the ultrasound of 5 of the uterine fibroids, and after the communication, the myomectomy was selected according to the individual's wishes. Intraoperative or full-hysterectomy. No hormone-related treatment was applied in the first three months, except for pre-operative diagnosis of endometrial lesions, post-operative pathology, It is proved to be a leiomyoma of the uterus. The patients with eclectomy The study method: The main questionnaire is SF-36 measurement table, and the auxiliary questionnaire is the symptom questionnaire and the sex life investigation of the post-menopausal transition period. Table, Statistical patient's hospital stay and time spent. All patients were completed before and after the operation and completed in June. The questionnaire was collected and different procedures were performed. The quality of life after operation was evaluated. The score of the questionnaire follows the system scoring method. The data statistics analysis The SPSS 13.0 software package is used. The statistical method uses t-test Test or chi-square test, reliability and validity analysis. P 0.0 5. The results were as follows:1. The SF-36 life quality measurement scale was applied to the patients with hysteromyoma and performed them. The evaluation of life quality was feasible and the effect was good. There was no difference between the two groups of SF-36 total score (p0.05). The SF-36 score after laparoscopic myomectomy was higher than that before operation (p0.05). The postoperative score of the hysterectomy group was lower than that before operation (p0.05), and the total number of the laparoscopic myomectomy group was clear after operation. The scores of physical function, general health, social function, emotional function and mental health were higher than that before operation (p <0.05). 0.05) The body function, physical function, general health, social function, emotional function and mental health of the total hysterectomy group were lower than before. At the same time, it was lower than that of the laparoscopic myomectomy group (p0.05).4. There was no difference between the two groups before operation (p0.05). The rate of life was higher than that of laparoscopic myomectomy (p0.05).5. There was no difference between the two groups before operation (p0.05). The quality of sexual life after laparoscopic myomectomy was no difference (p0.05). The incidence of sexual desire reduction, vaginal dryness and sexual anxiety after group operation The mean hospital stay in the laparoscopic myomectomy group was higher than that of the laparoscopic myomectomy group (p0.05). The average postoperative hospital stay was higher than that of the laparoscopic myomectomy group (p0.05). time, The operating expenses and the medical expenses are lower than the total laparoscopic hysterectomy de-group (p0.05). Conclusion:1, SF-36 quality of life for patients with uterine fibroids of 45-50 years The measurement scale can be applied to the measurement and evaluation of the quality of life of the patients with hysteromyoma, and has good performance. The overall quality of life of the patients with hysteromyoma was higher than that of patients with laparoscopic total hysterectomy.3. The laparoscopic myomectomy increased the quality of life of patients after operation. And the quality of life of the patients after laparoscopic total hysterectomy is reduced, and the physiological and mental health and mental health of the patients are affected. The incidence of the post-operation of the patients with laparoscopic total hysterectomy was higher than that of the patients with laparoscopic myomectomy. In response, the quality of sexual life after laparoscopic total hysterectomy was lower than that before operation and lower than that of laparoscopic myomectomy. 6. The time and cost of the laparoscopic myomectomy were lower than that of the laparoscopic total hysterectomy.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33
本文編號(hào)：2510603
[Abstract]:Study Background: Hysteromyoma is the most common benign tumor of female reproductive organs, with a rate of 20% and 30%, which is found in 30-50-year-old women. Sex. Hysteromyoma can be used for surgical and non-operative treatment, but so far, it has not been found that the curative effect is definite, can effectively avoid or control the non-operative treatment of the recurrence, so the operation therapy is still the most commonly used treatment measure in the patients with the current uterine fibroids. Application. The laparoscope has now become the main course of the gynecological operation. diameter. The laparoscopic operation for the treatment of hysteromyoma can be used for the selection of myomectomy and hysterectomy, and a hysterectomy is used in the patients with the uterine fibroids with the previous 45-year-old, and the occurrence of the uterine lesion is eliminated while the original disease is removed, and as the screening of the cervical diseases And the detection and treatment of the endometrial lesions of the hysteroscope, which can be found and treated in an early stage. With the improvement of the living standard, the demand for quality of life is also higher, and more and more people pay more attention to the problem of the retention of the uterus. The way of operation is the question of mutual interest between the doctor-patient and the doctor-patient In particular, in the case of postmenopausal women with uterine fibroids who have completed the birth, the choice of surgical procedure is more consistent with the physiological and psychological requirements of the patient. A Study on the Quality of Life of Postmenopausal Women with Different Methods of Operation and Investigation Spent. Pay attention to the improvement of the quality of life, and more embody the people-oriented medical science. The investigation and evaluation of the quality of life of the patient and the evaluation of the health economics of different operation procedures are the new prescription for understanding the burden of the disease and evaluating the curative effect of the patients. A. Research Objective: To investigate the quality of life quality of SF-36 before and after the operation of 45-50-year-old patients with hysteromyoma and the symptoms and sex of post-menopausal transition. To study the effect of laparoscopic myomectomy and laparoscopic total hysterectomy on the quality of life in the post-menopausal women with uterine fibroids. Economic evaluation, so as to provide guidance on the choice of operation and the quality of life after operation, and to explore a scientific and effective operation method for the patients with uterine fibroids in the transition period, and make the physiological-psychological-social medical pattern in the clinical of the gynaecology. to popularization and application . Study object: select 2013.1.1--2013.7.31 to be hospitalized for uterine fibroids in the hospital of Dalian Maternity Hospital The patients with endoscopic surgical treatment. The age of 45 to 50 years of age, the rule of menstruation, the ultrasound of 5 of the uterine fibroids, and after the communication, the myomectomy was selected according to the individual's wishes. Intraoperative or full-hysterectomy. No hormone-related treatment was applied in the first three months, except for pre-operative diagnosis of endometrial lesions, post-operative pathology, It is proved to be a leiomyoma of the uterus. The patients with eclectomy The study method: The main questionnaire is SF-36 measurement table, and the auxiliary questionnaire is the symptom questionnaire and the sex life investigation of the post-menopausal transition period. Table, Statistical patient's hospital stay and time spent. All patients were completed before and after the operation and completed in June. The questionnaire was collected and different procedures were performed. The quality of life after operation was evaluated. The score of the questionnaire follows the system scoring method. The data statistics analysis The SPSS 13.0 software package is used. The statistical method uses t-test Test or chi-square test, reliability and validity analysis. P 0.0 5. The results were as follows:1. The SF-36 life quality measurement scale was applied to the patients with hysteromyoma and performed them. The evaluation of life quality was feasible and the effect was good. There was no difference between the two groups of SF-36 total score (p0.05). The SF-36 score after laparoscopic myomectomy was higher than that before operation (p0.05). The postoperative score of the hysterectomy group was lower than that before operation (p0.05), and the total number of the laparoscopic myomectomy group was clear after operation. The scores of physical function, general health, social function, emotional function and mental health were higher than that before operation (p <0.05). 0.05) The body function, physical function, general health, social function, emotional function and mental health of the total hysterectomy group were lower than before. At the same time, it was lower than that of the laparoscopic myomectomy group (p0.05).4. There was no difference between the two groups before operation (p0.05). The rate of life was higher than that of laparoscopic myomectomy (p0.05).5. There was no difference between the two groups before operation (p0.05). The quality of sexual life after laparoscopic myomectomy was no difference (p0.05). The incidence of sexual desire reduction, vaginal dryness and sexual anxiety after group operation The mean hospital stay in the laparoscopic myomectomy group was higher than that of the laparoscopic myomectomy group (p0.05). The average postoperative hospital stay was higher than that of the laparoscopic myomectomy group (p0.05). time, The operating expenses and the medical expenses are lower than the total laparoscopic hysterectomy de-group (p0.05). Conclusion:1, SF-36 quality of life for patients with uterine fibroids of 45-50 years The measurement scale can be applied to the measurement and evaluation of the quality of life of the patients with hysteromyoma, and has good performance. The overall quality of life of the patients with hysteromyoma was higher than that of patients with laparoscopic total hysterectomy.3. The laparoscopic myomectomy increased the quality of life of patients after operation. And the quality of life of the patients after laparoscopic total hysterectomy is reduced, and the physiological and mental health and mental health of the patients are affected. The incidence of the post-operation of the patients with laparoscopic total hysterectomy was higher than that of the patients with laparoscopic myomectomy. In response, the quality of sexual life after laparoscopic total hysterectomy was lower than that before operation and lower than that of laparoscopic myomectomy. 6. The time and cost of the laparoscopic myomectomy were lower than that of the laparoscopic total hysterectomy.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 曹美良;不同術(shù)式切除子宮、卵巢對(duì)內(nèi)分泌及更年期癥狀的影響[J];實(shí)用婦產(chǎn)科雜志;2000年02期
2 楊燕飛;傅錦媚;阮祥燕;;子宮肌瘤患病年齡分布與追蹤研究[J];實(shí)用婦產(chǎn)科雜志;2008年05期
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