臺灣博碩士論文加值系統

口腔癌病人接受手術及放射線治療經常會導致口腔功能改變，尤其以牙關緊閉最常見，牙關緊閉會影響其生活品質。本研究目的為：(1) 探討口腔癌接受手術及放射線治療後咀嚼功能、憂鬱、牙關緊閉及生活品質程度。(2) 比較口腔癌接受手術及放射線治療後有牙關緊閉者與無牙關緊閉者咀嚼功能、憂鬱、牙關緊閉及生活品質之差異。(3) 找出能口腔癌接受手術及放射線治療後牙關緊閉的決定因子。研究採橫斷式相關性研究設計，以方便取樣於南部某區域教學醫院放射腫瘤科門診收案，以“15公分量呎”、“醫院焦慮憂鬱量表—憂鬱次量表”、“歐洲癌症組織生活品質量表-頭頸癌版”、“咀嚼功能問卷”、 “身體功能狀態量表”、及“基本資料表”為測量工具。資料以SPSS 17.0軟體分析，採描述性統計、t檢定、卡方檢定及邏輯斯迴歸等方法分析。共收集120位個案，研究結果為：(1)口腔癌病人有輕度至中度的咀嚼困難，其中咀嚼容易的食物前五名依序為豆腐、布丁、麵條、蛤蜊、蘿蔔糕及發糕等；病人有中度的憂鬱，有17.5%為憂鬱個案；平均最大張口距離為23.17mm；生活品質較差的層面依序為張口大小、牙齒、口乾、吞嚥、社交性用餐等。(2)牙關緊閉發生率76.6%；晚期腫瘤接受重建手術易發生牙關緊閉；有牙關緊閉者有較高程度的憂鬱及咀嚼困難；有牙關緊閉者有較差的社交性用餐及張口問題生活品質。(3)晚期腫瘤分期、接受重建手術的病人與牙關緊閉的發生有顯著相關。本研究結果可提供醫療人員暸解口腔癌病人接受手術及放射線治療後憂鬱、咀嚼功能、牙關緊閉及生活品質。提供臺灣地區口腔癌病人接受手術及放射線治療後牙關緊閉定義標準的參考，臨床護理人員須發展一套張口運動訓練及指引，協助病人確實執行張口訓練，提升病人咀嚼功能與生活品質。

Patients with oral cavity cancers who have surgical excision with radiation therapy (RT) or surgery with concurrent chemoradiation therapy (CCRT) may experience oral dysfunction, especially trismus, creating a negative effect on quality of life. The purpose of this study was to (1) examine chewing function, depression, trismus, and quality of life, (2) compare chewing function, depression, trismus, and quality of life in patients with trismus versus without trismus, and (3) examine the determinants of trismus in oral cavity cancer patients who received postoperative RT or CCRT.A cross-sectional correlational study was conducted. Outpatients selected from the radiation therapy department of a teaching hospital in southern Taiwan were enrolled using consecutive sampling. Patient subjective assessments were completed using a 15cm plastic ruler and questionnaires including the Hospital Anxiety and Depression Subscale - Depression Subscale, European Organization for Research and Treatment of Cancer- Quality of Life Head and Neck 35(EORTC-QLQ HN35), Chewing Function Questionnaire, , Karnofsky Performance Status Index. The data analysis was conducted with descriptive statistics, t-test, chi-square, and logistic regression. All calculations were made using SPSS for Windows, version 17.0(Chicago, IL, USA). A total of 120 oral cancer patients were recruited in this study. The results showed that patients had mild-to-moderate levels of chewing difficulty, and the top five foods for easy chewing according to descending frequency were tofu, pudding, noodles, clams, turnip cakes and steamed sponge cake. Patients had moderate levels of depression, with a prevalence of 17%. The average distance of maximal mouth opening was 23.17mm. The five top-ranked worse dimensions of quality of life were mouth opening, teeth loss, dry mouth, swallowing difficulty, social eating, and 76.6% of these patients were identified as having trismus. Patients with advanced cancer stage who received reconstructive surgery had significant trismus. Patients with trismus experienced greater depression and chewing difficultly than patients without trismus, and patients with trismus were more likely to report a worse quality of life in terms of social activities in dining and more troubles with opening their mouths. Advanced cancer stage, and having reconstructive surgery were significantly associated with trismus. The results of this study can help healthcare providers understand depression, chewing function issues, trismus and impacts on quality of life in oral cavity cancer patients who received postoperative RT or CCRT. The results provide a reference for definition in trismus. Clinicians should develop a mouth opening exercise program and help patients execute the program to improve chewing function and quality of life.

目 錄
第一章 緒論
第一節 前言 1
第二節 重要性 2
第三節 研究目的 3
第二章 文獻查證
第一節 口腔癌定義 4
第二節 口腔癌流行病學 5
第三節 口腔癌危險因子 6
第四節 口腔癌症狀 7
第五節 口腔癌診斷及分期 8
第六節 口腔癌治療 10
第七節 牙關緊閉 14
第八節 影響牙關緊閉相關因素 16
第九節 牙關緊閉評估與測量 18
第十節 口腔癌治療對口腔功能的衝擊 20
第十一節 影響生活品質的因素 21
第三章 研究方法
第一節 研究架構與假設 24
第二節 研究假設 25
第三節 名詞界定 26
第四節 研究設計 27
第五節 研究對象與場所 28
第六節 研究工具 29
第七節 研究步驟 33
第八節 研究倫理 35
第九節 資料分析與處理 36
第四章 研究結果 38
第一節 口腔癌接受手術及放射線治療後咀嚼功能、憂鬱、牙關緊閉及
生活品質程度 39
第二節 比較口腔癌接受手術及放射線治療後有牙關緊閉者與無牙關緊
閉者咀嚼功能、憂鬱、牙關緊閉及生活品質之差異 51
第三節 口腔癌接受手術及放射線治療後牙關緊閉的決定因子 57
第五章 討論
第一節 口腔癌接受手術及放射線治療後的咀嚼功能、憂鬱、牙關緊閉
及生活品質 59
第二節 有無牙關緊閉的咀嚼功能、憂鬱、牙關緊閉及生活品質之比較 62
第三節 口腔癌接受手術及放射線治療後牙關緊閉的決定因子分析 66
第六章 結論與應用
第一節 限制與建議 67
第二節 實務應用 68
第三節 結論 69
參考文獻
一、中文部份 70
二、英文部分 71
表目錄
表一 嘉義長庚紀念醫院頭頸癌治療臨床指引 (2010年2月修訂) 12
表二 嘉義長庚紀念醫院頭頸癌輔助性治療處方（2008年10月1日修訂） 13
表三 資料統計分析方法 37
表四 口腔癌接受手術及放射線治療後之人口學特性 40
表五 口腔癌病人接受手術及放射線治療後之疾病特性 42
表六 口腔癌病人接受手術及放射線治療後咀嚼功能-咀嚼容易得分分佈 44
表七 口腔癌病人接受手術及放射線治療後憂鬱得分分佈 46
表八 口腔癌病人憂鬱平均分數與標準差一覽表 46
表九 口腔癌病人接受手術及放射線治療後牙關緊閉最大張口測量距離 48
表十 歐洲癌症組織生活品質量表-頭頸癌版的得分分布 50
表十一 口腔癌病人接受手術及放射線治療後有無牙關緊閉的臨床特性與關聯 52
表十二 口腔癌病人接受手術及放射線治療後牙關緊閉最大張口測量距離 54
表十三 口腔癌病人接受手術及放射線治療後牙關緊閉之生活品質、憂鬱及咀嚼功能分析 56
表十四 口腔癌接受手術及放射線治療後牙關緊閉的決定因子邏輯斯迴歸分析 58
圖目錄
圖一 口腔癌病人接受手術及放射線治療後牙關緊閉決定因子與生活品質之
概念架構圖 24

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