胰臟與壺腹周圍腫瘤病患術前惡病質與術後三個月內體能變化之相關性探討

劉彥廷

doi:10.6342/NTU201600756

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胰脏与壶腹周围肿瘤病患术前恶病质与术後三个月内体能变化之相关性探讨

Correlation Between Cachexia and Changes of Physical Fitnessin the Patients with Pancreatic and Periampullary Tumor During Three months After Operation

刘彦廷 , 硕士　　导师：孙秀卿　　

繁体中文 DOI： 10.6342/NTU201600756

胰脏与壶腹周围肿瘤；手术；恶病质；体能； Pancreatic and Periamupllary Tumor ； Operation ； Cachexia ； Physical Fitness

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摘要 │ 参考文献 (91) │ 国际计量

摘要〈TOP〉

恶病质在胰脏与壶腹周围肿瘤病患术前常见症候群，而术後面临伤口癒合与体能复原过程，恶病质此症状易被忽视，且其影响病患生活品质与存活率甚钜。至今国际上仍未针对此族群，探查其恶病质与手术期间造成体能变化的相关研究。故本研究之目的为：(1)了解接受胰脏与壶腹周围肿瘤患者於手术前恶病质发生率与严重度；(2)了解此族群於术前至术後三个月内体能状态之变化；(3)了解此族群恶病质与术後三个月内体能状态变化之相关性。
    本研究自2015年11月25日至2016年6月21日於台北市某医学中心外科门诊进行收案，采纵贯式研究，分别於术前与术後一、二、三个月共四次资料收集，以预计接受胰脏切除肿瘤病患为收案对象，藉由结构式问卷收集资料，包括基本资料表、症状困扰严重度量表、疲倦量表；而体能测试项目，包含身体组成测量、惯用手握力与30秒坐站次数测量。资料分析采描述性统计分析各变项现况，以相关性统计分析相关体能的重要因子，并藉由广义推估方程式分析病患恶病质与手术期间体能变化的重要因子。
    研究期间共完成46位个案，四次资料收集完成率分别为46(T0)、43(T1)、43(T2)、43(T3)份，故问卷部分流失率为6.5%。研究结果显示：(1)恶病质发生率为44.1%，且恶病质组罹患糖尿病较高於非恶病质组；(2)胀气为病患术前最为困扰之症状，易饱为术後三个月内最困扰的症状，而疲倦位居第二或第三，属低中度疲倦范围，且症状困扰程度在术後二、 三个月显着低於术前；(3)在体能方面，体重与脂肪量随着手术三个月期间达显着下降，其他各项体能均无显着差异，影响术前体能重要因子包括：性别、年龄、KPS、血红素、白蛋白与术前置入胆管支架；(4)术前恶病质并未在手术期间成为影响体能变化之重要因子，而男性在体重、骨骼肌与手握力下降量大於女性，尤其在男性族群，术前血红素与白蛋白高者，其手术期间体能状态越好；而女性则是年纪轻且术前身体功能越高者，其手术期间体能状态越好。
    恶病质在接受胰脏肿瘤手术病患发生率高，且其手术前後体能皆低於一般健康民众，并在术後三个月内体重与脂肪量仍显着低於术前。因此，术後照护期间，需加强监测男性病患，尤其在术前血红素与白蛋白较差者，其在术後体能的变化，进而提供适当介入性措施：给予术後饮食卫教以提升营养摄取，鼓励持续维持术後身体活动，减少体重持续下降，进而重建与促进手术期间原有的体能。

并列摘要〈TOP〉

Cachexia is the common syndrome among the patients with pancreatic and periampullary tumor before surgery. Since the process of the wound healing and the recovery in physical fitness during the post-operation, cachexia is easily ignored. Consequently, cachexia strongly impacts the quality of life and even the survival rate. However, there is no study to explore the correlation between cachexia and the changes of physical fitness in the patients with pancreatic and periampullary tumor during operation. Therefore, the purpose of this study was to explore (1) the prevalence and severity of cachexia before operation, (2) the change of physical fitness during three months after operation, and (3) the correlation between cachexia and the change of physical fitness within three months.
   A longitudinal designed study was conducted on the patients with pancreatic and periampullary tumor undergoing the surgery in the surgery outpatient. The data were collected four times at peri-operation (T0) and post-operation 1, 2, 3 months (T1, T2, T3) from 25 November in 2015 to 21 June in 2016. A set of structured questionnaire was used to collect data including the demographic and clinical characteristic, the Symptom Severity Scale (SSS) and the Fatigue Symptom Inventory (FSI). Besides, patients were received the test of physical fitness including the body composition, the strength of hand grip and 30-second sit-to-stand test (STS-30). The descriptive statistics was used to analyze the each variable and the correlation statistics was used to explore the independent variable in the physical fitness. Lastly, the generalized estimating equations (GEE) was used to analyze cachexia and the change of physical fitness during operation. 
   Totally, 46 patients completed this survey and the attribution rate was 6.5% during the period of data collecting. The results had shown that (1) the prevalence of cachexia was 44.1% and the group of cachexia had more DM than the group without cachexia; (2) the flatulence was the most severity symptom before operation and the early satiety was the most severity symptom within three months of post operation. Moreover, the fatigue was ranking second or third, which belonged to mild to moderate fatigue during three months after operation. However, the overall severity of symptom was significant lower in the second and third month of post-operation (T2, T3) than pre-operation (T0); (3) the body weight and the fat mass were significant decrease within three months after operation. Besides, the significant factors of physical fitness before surgery included gender, age, KPS, hemoglobin, albumin and implanting the bile stent before surgery, and (4) Even though cachexia was not independent factor in the physical fitness within three months after operation, the male decreased in the body weight, the skeletal muscle mass and the strength of hand grip more than the female. Besides, the population of the male with higher level of hemoglobin and albumin and the population of the female with younger and higher KPS’s scoring had better physical fitness performance during the recovery of operation.
    Cachexia is high prevalence among patients undergoing pancreatic surgery and these patients had worst level of physical fitness than the healthy people. The patients still significant lower in body weight and the fat mass within three months after surgery. Therefore, the health providers should put more attention to the population of the male on the change of physical fitness especially those were lower level of hemoglobin and albumin. These patients were received appropriate interventions to gain more nutritional supplement, maintain physical fitness and decrease the loss of body weight. Those multiple interventions lead to rebuild and promote the physical fitness after operation.

参考文献 ( 91 ) 〈TOP〉

田郁文、李伯皇 (2006)。胰脏癌。台湾医学，10(4)，493-498。
连结：
郭绪东、张天长、汪在莒 (2011)。体适能的检测与评估。家庭医学与基层医疗， 26(1)，19-27。
连结：
廖幼婕、李芸湘、赖裕和(2011)。癌症食慾不振和恶病质症候群之处置。肿瘤护理杂志，11(2)，11-21。
连结：
Ahn, D. H., & Bekaii-Saab, T. (2014). Ampullary cancer: an overview. Am Soc Clin Oncol Educ Book, 112-115. doi: 10.14694/EdBook_AM.2014.34.112
连结：
Bachmann, J., Heiligensetzer, M., Krakowski-Roosen, H., Buchler, M. W., Friess, H., & Martignoni, M. E. (2008). Cachexia worsens prognosis in patients with resectable pancreatic cancer. Journal of Gastrointestinal Surgery, 12(7), 1193-1201. doi: 10.1007/s11605-008-0505-z
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