Quality-of-life evaluation after microvascular oromandibular reconstruction: a comparative study of reconstructed and nonreconstructed patients

Abstract

目的: 分析口腔癌患者下頜骨區段缺損術后骨性重建對生活質量(quality of life,QOL)的影響。方法: 17例因口腔癌而致下頜骨區段切除的患者按重建術式的不同分為骨性重建組和非骨性重建組,同時采用SF-36、FACT-H&N和UW-QOL三種量表分別在術前、術后3個月和術后12個月進行生活質量的測量,比較兩組患者生活質量的差異及縱向變化趨勢。結果: 兩組患者術前生活質量的差異無顯著性,而在術后3個月和術后12個月兩個時點,骨性重建組均有較好的外貌、進食、功能狀況和總體生活質量(P<0.05)。術后12個月時,骨性重建組的生活質量恢復到了接近術前水平,而非骨性重建組仍遺留有較嚴重的口腔相關的特異性問題和較差的功能狀況。結論: 下頜骨區段缺損后的骨性重建能改善患者的外形和功能,提高患者術后的QOL,值得在臨床上推廣使用。

Objective: To analyze the impact of reconstructive procedure on the quality of life (QOL) of patients who had undergone segmental mandibulectomy because of oral cancer. Methods: Seventeen patients who had undergone segmental mandibulectomy were divided into two groups based on the reconstructive technique utilized. Ten patients were placed in the osseous reconstruction group,7 patients were placed in the non-osseous reconstruction group. Quality of life of all patients was assessed preoperatively and at 3 months and 12 months after surgery by means of three questionnaires SF-36 (Chinese version), FACT-H&N (Version 4.0) and UW-QOL (Version 4.0) which was translated directly. The differences between groups and longitudinal trends over time were analyzed. Results: Preoperatively, there was no statisticallly difference between groups. At 3 months and 12 months after surgery, osseous reconstruction produced a perceived better appearance, better eating ability, better functional well-being and a better overall quality of life (P<0.05). The scores of patients in the osseous reconstruction group approached pretreatment level by 12 months, while patients in the non-osseous reconstruction group showed lower values in disease-specific problems and fuctional well-being by 12 months. Conclusion: Restoration of mandibular continuity by free fibula flap after segnental mandibulectomy leads to improved appearance, functional well-being and a superior quality of life. It deserves to be popularized in clinical work.