膵頭十二指腸切除術を受け退院した患者における生活の価値・満足度からみたクオリティ・オブ・ライフの検討

AN EVALUATION OF THE QUALITY OF LIFE FOR POST-P. D. SURVIVORS AT HOME USING AN INDEX OF PATIENT SATISFACTION

要約

　近年，膵臓がんは増加傾向にあり，その根治術として膵頭十二指腸切除（以下PD術）が施行されているが，生存率は低く術後の生活管理が難しいといわれている．そこで，患者の価値・満足度からみたQOLと客観的なQOLの関係と，それに影響を及ぼす要因を知るために，フィランス・パワーズの生活満足度指標，PerformanceStatusの2種類の既存のスケールと，私達が作成した術後生活調査質問用紙を用いて，訪問による面接調査を行った．その結果，QOLは術式間で有意差はなく，患者自身の主観的な評価と医療者側の客観的な評価は一致しなかった．また，QOLに影響を及ぼす要因として，下痢の有無・外出の可否・年齢・食事作りの負担・配偶者の有無・がんの認識の順であげられた．

　今回の研究より，PD術後患者は機能障害を残したとしても主観的なQOLは高く，それを左右する要因は家族のサポートに起因するものが多かった．

Abstract

　Many patients suffering from pancreatic cancer undergo a pancreatoduodenectomy (PD), but the survival rate is low, and post-operative daily activity is difficult. The purposes of this study were to investigate : 1)The relationship between the subjective and objective evaluations of quality of life(QOL)using two scales ; and 2)The factors which influence QOL of the post-operative pancreatic carcinoma patient.

　The subjects were 23 PD patients who survived for 1 to 19 years. We visited the patients' homes to interview them and to administer a Quality of Life Index survey Cancer Version(QLI-CV, Ferrans ＆ Powers)and a questionnaire about daily life after the operation. The Performance Status Scale survey(PS)was filled out by two visiting nurses. The QLI survey was administered to establish a subjective index of QOL, whereas the PS survey was filled out by the nurses to establish an objective index. We used these indices to evaluate QOL within the framework outlined by the answers to questions about daily life after the operation.

　The results were : 1)The QLI scores exhibited hardly any variation regardless of the extent of the operation ; 2)The QLI scores didn't correspond with the PS scores ; 3)Of the factors included in the questionnaire, the six which most influenced the QLI scores in order of influence were : patient had diarrhea or not ; patient could leave home or not ; age ; patient could cook or not ; marital status ; and patient was aware of their cartinoma diagnosis or not.

　After PD the patients' QOL was good even when further digestive organs' disorders remained. Since of the six factors mentioned above three were closely ralated to family relationship, we believed more detailed reseach is needed in the area of family support.