不同術式之良性攝護腺肥大症患者生活品質探討

Abstract

良性攝護腺肥大症（BPH）是一種常見的老年疾病，在過去最有效的根除方式仍是以經尿道攝護腺電刀切除術（TURP）為主，但近年開始以雷射（Laser）手術來代替電刀，國內外臨床報告中已證實有效，但在術後生活品質上的相關研究仍極少見，台灣地區僅有少數在臨床上的報告，與生活品質相關更是少見。 本研究針對某醫學中心在2006.1~2008.12間，接受兩種術式之病患共150名進行生活品質相關探討，以世界衛生組織生活品質問卷（WHOQOL）、國際攝護腺症狀分數（IPSS）、臨床症狀三種進行病患特性、術前與術後生活品質與疾病狀態改變衡量，比較病患是否會因接受不同手術方式而有所差異。 研究結果發現：病患在手術方式的選擇上，會因為年齡、教育程度、是否合併其他慢性疾病、家庭收入而有所不同。但不論接受何種手術方式，病患在術後改善情形均佳，其IPSS與滿意度均有大幅提升，而Laser手術方式在臨床結果上也能達到大幅改善症狀的效果，並可降低因手術所產生之風險。而接受Laser手術方式病患其生活品質健康狀態在心理範疇與社會網路滿意度明顯優於接受TURP之病患。 由本研究可知，雷射攝護腺手術的臨床效果與傳統電刀手術相似，但術後的生活品質卻有較佳的表現，且手術的安全度明顯較高，期望研究結果能作為健保給付政策之決策者的參考。

Benign prostate hyperplasia (BPH) is a common disease of old age. Traditionally, the most effective treatment is transurethral resection of the prostate (TURP). However laser prostatectomy (LP) becomes very popular in recent years. Many clinical reports had approved its result of treatment. But there are only few investigations concerning the quality of life after prostatectomy. No publication about this area was seen in Taiwan. Our research studied 150 cases of BPH patients receiving TURP or LP in one medical center in North Taiwan. Post-operation quality of life is the main interest. Life quality questionnaire from World Health Organization (WHOQOL), International Prostate Symptom Score (IPSS) and change of clinical symptoms were used to see any difference of patient character or any changes of life quality after different operation methods. The results showed age, education, concomitant chronic medical diseases and family income will affect the patients to choose different methods of surgery. Both surgical methods can get equal good results of clinical symptoms. Laser prostatectomy may have less surgical risks. On the other hand, comparing with TURP, it may get better improvements about quality of life especially in the aspects of health of psychology and satisfaction of social relationships. Conclusively, LP may have the same clinical efficacy as TURP and having better post-operation quality of life. It also has less surgical risks. We wish the result of this research may be a useful reference for decision makers of policy of national health insurance.