腹腔镜食管裂孔疝修补术后生命质量及其影响因素分析

Quality of life and its related influencing factors after laparoscopic hiatal hernia repair

  • 摘要:
    目的 探讨腹腔镜食管裂孔疝修补术(LHHR)后患者的生命质量及其影响因素。
    方法 采用回顾性队列研究方法。收集2020年8月至2022年4月首都医科大学附属北京朝阳医院收治的215例行 LHHR患者的临床资料;男90例,女125例;年龄为(62±14)岁。患者于LHHR后6个月进行症状评分和生命质量评估。正态分布的计量资料以x±s表示,组内手术前后比较采用配对t检验;偏态分布计量资料采用M(范围)表示。影响因素分析采用逐步线性回归分析。基于AIC(Akaike信息准则)原则选择最优模型。
    结果 (1)治疗情况。215例患者中,行LHHR+胃底折叠术(Dor术)162例,行LHHR+重建HIS角53例。215例患者术后6个月烧心症状视觉模拟量表(VAS)评分为0(0~4)分、反酸症状VAS评分为0(0~9)分、嗳气症状VAS评分为0(0~9)分、胸痛症状VAS评分为0(0~9)分、早饱症状VAS评分为0(0~9)分。(2)手术前后生命质量评估情况。215例患者行LHHR前生理机能健康调查简表(SF‑36)评分为(80±24)分、术后为(87±18)分;术前生理功能SF‑36评分为(49±45)分、术后为(68±38)分;术前躯体疼痛SF‑36评分为(65±23)分、术后为(74±19)分;术前一般健康状况SF‑36评分为(46±7)分、术后为(51±9)分;术前精力SF‑36评分为(67±19)分、术后为(75±17)分;术前社会功能SF‑36评分为(71±24)分、术后为(81±18)分;术前情感职能SF‑36评分为(60±45)分、术后为(77±33)分;术前精神健康SF‑36评分为(68±19)分、术后为(76±17)分;术前健康变化SF‑36评分为(33±19)分、术后为(57±28)分;上述指标术前和术后比较,差异均有统计学意义(t=-7.82,-8.73,-8.20,-10.08,-9.75,-8.83,-8.00,-9.88,-12.95,P<0.05)。(3)影响LHHR后6个月身体成分总评分(PCS)和心理成分总评分(MCS)的因素。多因素分析结果显示:性别、年龄、精神疾病、脑梗死、低蛋白血症、术后6个月反酸和胸痛VAS评分是LHHR后6个月PCS的独立影响因素(P<0.05);精神疾病、恶性肿瘤、低蛋白血症、术后6个月烧心和嗳气VAS评分是LHHR后6个月MCS的独立影响因素(P<0.05)。
    结论 LHHR可改善患者生命质量。性别、年龄、精神疾病、脑梗死、低蛋白血症、术后6个月反酸和胸痛VAS评分是LHHR后6个月PCS的独立影响因素;精神疾病、恶性肿瘤、低蛋白血症、术后6个月烧心和嗳气VAS评分是LHHR后6个月MCS的独立影响因素。

     

    Abstract:
    Objective To investigate the quality of life (QoL) and its related influencing factors of patients undergoing laparoscopic hiatal hernia repair (LHHR).
    Methods The retrospec-tive cohort study was conducted. The clinical data of 215 patients undergoing LHHR in Beijing Chaoyang Hospital of Capital Medical University from August 2020 to April 2022 were collected. There were 90 males and 125 females, aged (62±14)years. All patients underwent symptom scoring and quality of life assessment 6 months after LHHR. Measurement data with normal distribution were represented as Mean±SD, and comparison before and after operation within the group was conducted using the paired t test. Measurement data with skewed distribution were represented as M(range). Stepwise linear regression analysis was used for influencing factors analysis. Optimal model was selected based on Akaike information criterion.
    Results (1) Treatment. Of 215 patients, 162 cases underwent LHHR+gastric fundus folding surgery (Dor surgery), and 53 cases underwent LHHR+reconstruction of HIS angle. The score of visual analogue scale (VAS) of heartburn symptoms in 215 patients 6 months after surgery was 0(range, 0-4), with the score of VAS of acid reflux symptoms was 0(range, 0-9), the score of VAS of belching symptoms was 0(range, 0-9), the score of VAS of chest pain symptoms was 0(range, 0-9), the score of VAS of early satiety symptoms was 0(range, 0-9), respectively. (2) Assessment of QoL before and after surgery. The score of MOS item short from health survey (SF‑36) of physiological function in 215 patients before and after LHHR was 80±24 and 87±18, with the score of SF‑36 of physiological functionality before and after LHHR was 49±45 and 68±38, the score of SF‑36 of body pain before and after LHHR was 65±23 and 74±19, the score of SF‑36 of general health condition before and after LHHR was 46±7 and 51±9, the score of SF‑36 of vigour before and after LHHR was 67±19 and 75±17, the score of SF‑36 of social function before and after LHHR was 71±24 and 81±18, the score of SF‑36 of emotional function before and after LHHR was 60±45 and 77±33, the score of SF‑36 of emotional health before and after LHHR was 68±19 and 76±17, the score of SF‑36 of health change before and after LHHR was 33±19 and 57±28. There were significant differences in the above indicators before and after surgery (t=-7.82, -8.73, -8.20, -10.08, -9.75, -8.83, -8.00, -9.88, -12.95, P<0.05). (3) Factors influencing physical compo-nent summary (PCS) and mental component summary (MCS) 6 months after LHHR. Results of multi-variate analysis showed that gender, age, mental disease, cerebral infarction, hypoproteinemia, score of VAS of acid reflux 6 month after surgery and score of VAS of chest pain 6 month after surgery were independent factors influencing PCS 6 months after LHHR (P<0.05), and mental disease, malignant tumor, hypoproteinemia, score of VAS of heartburn 6 month after surgery and score of VAS of belching 6 month after surgery were independent factors influencing MCS 6 months after LHHR (P<0.05).
    Conclusions LHHR can improve patients′ QoL. Gender, age, mental disease, cerebral infarc-tion, hypoproteinemia, score of VAS of acid reflux 6 month after surgery and score of VAS of chest pain 6 month after surgery are independent factors influencing PCS 6 months after LHHR, and mental disease, malignant tumor, hypoproteinemia, score of VAS of heartburn 6 month after surgery and score of VAS of belching 6 month after surgery are independent factors influencing MCS 6 months after LHHR.

     

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