Comparative Study Of Quality Of Life Between SNSRH And MRH

Cervical cancer is one of the most common malignant tumor of the female reproductive system, which seriously harm to the health of women in general. In recent years, new features of the incidence of cervical cancer and treatment emerge. The incidence is more younger. Clinical effects of surgical treatment improve. The overall5-year survival rate has reached60to70%. The5-year survival rate of patients with early stage is almost90%. And with the improvement of living standards, quality of life of patients with cervical cancer has been requested higher and higher. For I a2-II a period of cervical cancer, surgery and radiotherapy are equally effective, but for younger patients with cervical cancer, surgery has more advantages. Radical hysterectomy(RH) and pelvic lymph node dissection is classic surgery for cervical cancer, but RH were significant effects of surgery in the same time also brought a lot of irreversible complications, such as lower urinary tract/bladder dysfunction (sensory loss, storage and voiding dysfunction, urinary incontinence, the bladder pressure instability), anal/rectal dysfunction (bleeding, constipation/diarrhea, change in bowel habits) and vulva/vagina dysfunction (low libido, sexual arousal disorder, orgasmic and sexual pain), and many other complications seriously affecting the quality of life of patients. In order to reduce postoperative complications and the impact on quality of life, domestic and foreign scholars conducted a modified RH operation. The one is preserve autonomic nerve, systematic nerve-sparing radical hysterectomy (SNSRH), whose points is retaining the dominance of good bladder, rectum, vulva and other pelvic autonomic nerve (PAN), to ensure that the scope of surgical resection and reduce complications and possible effect on quality of life. The other is narrow the scope of surgery, underwent modified radical hysterectomy (mRH). The former carried out in the country has only just begun, and the latter carried out a long history in China. This study is part of "Research series on minimally invasive treatment of cervical cancer", which compare quality of life of during two surgical procedures with the universal application of international scale.Quality of Life Questionnaire-Core30(QLQ-C30) is developed by the European Organization for Research and Treatment of Cancer (EORTC), which is an international, cross-cultural measurement tool has tested dozens of countries. Its reliability, validity and sensitivity have been validated in many countries, successfully applied to cancer patients in clinical research. QLQ-C30(v3.0) has15areas including the five functional areas, nine symptom areas and a general health component. Because of patients with subjective symptoms in the field by greater impact, more than a single symptom items, a relatively greater individual differences, and measure it more difficult for definition, we should not address the symptoms in the field of quality of life, only in respect functional areas and overall health quality of life for a preliminary study of small samples. Research is divided into two parts: the first part is trends of quality of life on functional areas and overall health before and after surgery (SNSRH or mRH); the second part is Comparative Study of Quality of Life about SNSRH and mRH functional areas and overall health status of before and after surgery. The results show:First quality of life trend in functional areas and overall health before and after SNSRH was consistent with mRH. Second quality of life in functional areas and overall health of patients with cervical or endometrial cancer before and after surgery was linear regression with age, education, family economic status, postoperative chemotherapy, postoperative radiotherapy, in which postoperative radiotherapy was negatively correlated with quality of life in functional areas and overall health status. Third SNSRH was broader than mRH, and had longer time and more bleeding. Fourth in the functional areas and overall health status, preoperatively there was no significant difference, but only SNSRH had little worse quality of life in functional areas postoperatively than mRH. Fifth because of retaining the PAN, the SNSRH had better recent quality of life.Part One:quality of life trend before and after SNSRH and mRH【Purpose】To assess the change trend of quality of life of patients with cervical or endometrial cancer before and after two surgical procedures with the functional areas and overall health status in QLQ-C30(v3.0) developed by European Organization for Research and Treatment of Cancer (EORTC). To learn quality of life trends in functional areas and overall health status before and7-10days,1month,3months and6months after SNSRH and mRH, and to learn more about the relationship between6common factors in the functional areas and overall health status in QLQ-C30(v3.0) and analyze the factors associated with quality of life.【method】64patients with cervical cancer or endometrial cancer according to the inclusion criteria were randomly assigned into receive SNSRH and mRH.21patients of32patients in SNSRH group have complete quality of life data before and7-10days,1month,3months and6months after SNSRH.22patients of other32cases in mRH group has complete quality of life data before and7-10days, a month,3months and6 months after mRH. Forward-looking analysis of the two groups was conducted respectively.【result】With the functional areas and overall health status in EORTC QLQ-C30(v3.0), in general, the trend of quality of life of two groups showed from functional fields and overall health were consistent, the lowest in the7-10days after surgery,1and3month gradually restored, and6months return to preoperative status.Quality of life in functional areas and global quality of life before and after surgery was linear regression with age, education, family economic status, postoperative chemotherapy, postoperative radiotherapy, in which postoperative radiotherapy was negatively correlated with quality of life in functional areas and overall health status.Part two:Comparative Study of SNSRH and mRH about quality of life before and after surgery[Purpose]The purpose of this study was to compare general information of SNSRH and mRH,including basic information of patients, operation time, blood loss and surgical area;assessment of functional areas and overall health status at7-10days,1month,3months,6months after operation was to camparing quality of life of patients undergoing SNSRH and mRH.【method】The method of grouping of patients was described the first part. All patients through SNSRH and mRH were operated on by surgeons according to their own standard.The aim of study was to find whether any diffence about quality of life would exist in two groups by comparing the mean operating time, blood loss, functional field and general health status of patients undergoing SNSRH and mRH at7-10days,1month,3months and6months after surgery with EORTC QLQ-C30(v3.0) questionnaire.[result]One.According to the basic date,no significant differences was found about general infoemation of two groups of patients.However,the operating time, blood loss and operative field of SNSRH and mRH are significantly different.Two.Based on the analysis of functional field,the physical function and social function of two groups of patients before surgery and7-10days,1month after operation were not significant different,but difference were found at3months and6months after operation. Physical function of two groups of patients at3months and6months after operation relatively were SNSRH (88.57±11.57) VS mRH (93.94±14.68),Z=2.652, P=0.008, SNSRH (93.02±8.29) VS mRH(94.85±17.20), Z=2.353、P=0.019; Social function of two groups of patients at3months and6months after operation relatively were SNSRH (80.16±6.15) VS mRH (93.18±9.69), Z=2.501、P=0.012, SNSRH (82.54±9.35) VS mRH (90.15±1.14), Z=2.649, P=0.008。The role function of two groups of patients before surgery and7-10days were not significant different,However difference were found at1months,3months and6months after operation:SNSRH (72.22±23.17) VS mRH (96.21±11.42), Z=4.055, P=0.000, SNSRH (81.75±23.51) VS mRH (96.97±11.07), Z=3.207. P=0.001, SNSRH (88.10±19.11) VS mRH (97.72±10.66), Z=2.294、P=0.022。 Emotional function and cognitive function of two groups of patients were not significantly different before and after operation.Three:According to global quality of life:There were no significant differences about global quality of life of in the before、7-10days、1month between SNSRH and mRH. 【Conclusion】One.Reliability, validity and sensitivity of the EORTC QLQ-C30(v3.0) Questionnaire is excellent. Trend of quality of life of SNSRH and mRH can be reflected by function field and overall health status of patient,in addition, this trend is consistent。Two. Many factors will influence the functional areas and overall health status,and a linear regression relation will exsite between status of life of patient and age, educational background,status of economic,postoperative chemotherapy and postoperative radiotherapy, besides,postoperative radiotherapy was a negative correlation with quality of life.Three. According to the basic data,the operative time of SNSRH is longer than the one of mRH,extent of resection larger, blood loss more evident.Four By the analysis of Quality of life about functional areas, emotional function and cognitive function of the patients from two groups were not significantly different before and after surgery.At3months and6months after the operations body function and social function of SNSRH was slightly lower than mRH.Five.From the analysis based on the general health, patients of the two groups were not significantly different before and after operation.In summary:operative time was longer and blood loss was more during SNSRH than mRH,but doctors could retained the pelvic autonomic nerves bySNSRH, postoperative quality of life of the patients were not worse than the one of mRH.