【摘要】 目的 分析手術治療垂體瘤患者長期臨床恢復以及生活質量改善情況。 方法 回顧性分析2007年12月-2008年9月手術治療的103例垂體瘤患者術前以及術后長期隨訪資料，使用SF-36量表對術前、術后患者生活質量進行評估，分析手術治療前后患者癥狀、激素水平恢復情況以及生活質量改善情況，并進一步分析腫瘤大小、侵襲程度對術后生活質量的影響。 結果 術后頭痛癥狀消失52例，視力改善76例，其他癥狀具有不同程度改善；術后SF-36生活質量評估結果顯示，患者除精神健康外的7個維度（生理機能、生理職能、軀體疼痛、一般健康狀況、精力、社會功能、情感職能）均有明顯改善（P＜0.05），不同腫瘤大小及侵襲程度的患者術后生活質量評分均無統計學意義（P＞0.05），垂體功能完全恢復者生活質量評分高于垂體功能低下者（P＜0.05）。 結論 顯微手術治療垂體瘤患者可明顯改善患者的一般癥狀、提高患者的生活質量，單純腫瘤的大小和侵襲程度對術后生活質量的影響程度較小，術后垂體功能的恢復程度明顯影響患者的生活質量，垂體瘤術后患者的激素長期替代治療尚需進一步加強。【Abstract】 Objective To analyze the long-term clinical recovery and quality of life (QoL) in patients with pituitary adenoma treated by microneurosurgery. Methods The clinical data of 103 patients undergoing microneurosurgery from December 2007 to September 2008 were retrospectively analyzed, health-related questionnairs (SF-36) were used to assess the QoL. The post-surgery recovery of symptoms, endocrine function, and QoL were compared with those of pre-surgery, then the correlation between tumor size, invasive behavior, and QoL were analyzed. Results Headache disappeared in 52 patients. Visual symptoms improved in 76 patients. Other symptoms were also improved. Seven concepts (physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotioning) were improved after surgery (Plt;0.05). The eight health concepts of SF-36 showed no significant difference between patients with different tumor size and invasive behavior (Pgt;0.05). Differences were considered statistically significant between normal and abnormal pituitary function groups after surgery(Plt;0.05) in all concepts. Conclusion Microneurosurgical treatment can improve the general symptoms and the QoL. The tumor size and invasion have little influence on the QoL after surgery, but the improvement of hormone deficiency has influence on the QoL significantly. More attention should be given to the long-term hormone replacement therapy after the pituitary adenoma surgery.
【摘要】 目的 了解四川省基層醫療衛生機構基本醫療功能開展情況，以便有針對性地采取措施，提高基層醫療衛生機構的服務能力。 方法 2008年8月采用自填式問卷調查的方法，對基層醫療衛生機構開展的基本醫療功能情況進行調查。 結果 基層醫療衛生機構提供的三類基本醫療功能（基本檢查項目、常見病診療、家庭診療及轉診）總體情況不甚理想，基本檢查項目開展情況社區衛生服務中心好于鄉鎮/街道衛生院。一級項目中除社區衛生服務中心轉出服務開展比例達100%外，大部分醫療衛生機構一級、二級項目開展不全，社區衛生服務中心與鄉鎮/街道衛生院X線檢查開展比例均在50%左右，常見病診療部分一級項目開展機構的比例不到30%。家庭診療及轉診二級項目兩類機構開展比例均較低。 結論 基層醫療衛生機構提供的基本醫療功能特別是常見病診療項目有待加強。【Abstract】 Objective To understand the situation of basic medical services in primary medical institutions of Sichuan province so as to take related measures to improve the medical services in primary medical institutions. Methods We used self-administered questionnaires to investigate the basic medical services in primary medical institutions in August, 2008. Results The general situation of the three types of basic medical services (basic examination items, common disease diagnosis and treatment, family diagnosis and treatment and referrals) was not very good, but the development of basic examination items in the community health service center was better than that in villages and town hospitals or street service center. Among all kinds of first-grade medical health services, except for that the referral service in community health service center accounted for 100%, most of the first and second-grade medical health services were not fully developed. The proportion of X ray detection in community health service center and villages and town hospitals or street service center was about 50%, and the development of common disease diagnosis and treatment among the first grade medical health services accounted for only 30%. The proportion of family diagnosis and treatment and referrals was low. Conclusion The basic medial services in primary medical institutions should be strengthened, especially for the common disease diagnosis and treatment.