CAJ | 학술논문

目的：探讨乳腺癌乳房切除术（MRM）、乳房切除后重建术（BR）及保乳术（BCS）3种手术方式患者术前对术后生活质量和疾病相关耻辱感预测的准确性。方法选取2009年3月-2012年12月辽宁医学院附属第一医院乳腺外科收治的女性乳腺癌患者325例，根据手术方式不同分为MRM组46例，BR组68例，BCS组211例。通过邮件和采访的方式进行调查。评估患者的生活质量（0＝最差的，100＝最好的）和疾病相关耻辱感（1＝极度感到耻辱，5＝从未感觉耻辱）。采用线性回归方法比较患者生活质量及疾病相关耻辱感的术前预测值和术后实际值的关系。结果 MRM组、BR 组、BCS 组患者术后生活质量评分较术前升高，术后疾病相关耻辱感评分较术前降低（ P ＜0.05）。3组术前生活质量评分和疾病相关耻辱感评分比较，差异均有统计学意义（ P＜0.05）；其中MRM组较BR组、BCS组生活质量评分降低，疾病相关耻辱感评分升高（ P＜0.05）。直线回归分析结果显示，生活质量和疾病相关耻辱感术前预测值与术后实际值有直线回归关系（ P＜0.05）。结论3种手术方式的患者术前对术后生活质量和疾病相关耻辱感的预测均是不准确的，尤其是MRM。
목적：탐토유선암유방절제술（MRM）、유방절제후중건술（BR）급보유술（BCS）3충수술방식환자술전대술후생활질량화질병상관치욕감예측적준학성。방법선취2009년3월-2012년12월료녕의학원부속제일의원유선외과수치적녀성유선암환자325례，근거수술방식불동분위MRM조46례，BR조68례，BCS조211례。통과유건화채방적방식진행조사。평고환자적생활질량（0＝최차적，100＝최호적）화질병상관치욕감（1＝겁도감도치욕，5＝종미감각치욕）。채용선성회귀방법비교환자생활질량급질병상관치욕감적술전예측치화술후실제치적관계。결과 MRM조、BR 조、BCS 조환자술후생활질량평분교술전승고，술후질병상관치욕감평분교술전강저（ P ＜0.05）。3조술전생활질량평분화질병상관치욕감평분비교，차이균유통계학의의（ P＜0.05）；기중MRM조교BR조、BCS조생활질량평분강저，질병상관치욕감평분승고（ P＜0.05）。직선회귀분석결과현시，생활질량화질병상관치욕감술전예측치여술후실제치유직선회귀관계（ P＜0.05）。결론3충수술방식적환자술전대술후생활질량화질병상관치욕감적예측균시불준학적，우기시MRM。
Objective To investigate the accuracy of preoperative forecasts for postoperative quality of life( QoL)and disease-related stigma among breast cancer patients who received mastectomy without reconstruction ( MRM ), breast recon-struction(BR)and breast conserving surgery(BCS). Methods A total of 325 female breast cancer patients who were treated in breast surgery,the First Hospital Affiliated to Liaoning Medical College from March 2009 to December 2012,were selected as study subjects,and were divided into MRM group(46 cases),BR group(68 cases)and BCS group(211 cases)according to type of surgical procedure,the patients were investigated by email and interviews. The QoL(0=worst,100 = best)and dis-ease-related stigma(1 = extreme stigma,5 = no stigma). The relationship between preoperative predicted value and postop-erative actual value of QoL and disease-related stigma were compared by using linear regression method. Results In MRM,BR and BCS group,postoperative values of QoL were significantly higher than preoperative values of QoL,postoperative values of disease-related stigma were significantly lower than preoperative values of disease-related stigma(P<0. 05). There were sig-nificant differences in preoperative values of QoL and disease-related stigma among three groups(P<0. 05). The value of QoL in MRM group was significantly lower than those in BR and BCS group,value of disease-related stigma in MRM group was sig-nificantly higher than those in BR and BCS group( P<0. 05 ) . Linear regression analysis results showed that the difference be-tween preoperative predicted value and postoperative actual value of QoL and disease-related stigma was statistically significant (P<0. 05). Conclusion The preoperative forecasts for postoperative QoL and disease-related stigma among breast cancer pa-tients who received 3 types of surgical procedure were inaccurate,forecasts for patients who received MRM were especially inac-curate.