基于计划行为理论结合肝胆康复操的运动训练对腹腔镜下肝癌切除术患者术后康复的影响

doi:10.3969/j.issn.1009-976X.2026.03.004

摘要/Abstract

摘要： 目的探讨基于计划行为理论并结合肝胆康复操的运动训练对腹腔镜下肝癌切除术患者术后康复的影响。方法选取2021年10月至2023年7月在广东某三甲医院行腹腔镜下肝癌切除术的69例患者为研究对象,采用随机数字表法分为观察组（n=35）和对照组（n=34）。对照组接受常规术后康复干预;观察组在此基础上采用基于计划行为理论结合肝胆康复操的结构化运动训练,干预总时长为4周。于干预前及干预4周后,评估两组主要结局指标（运动依从性、一般自我效能感量表（GSES）评分）及次要结局指标（Herth希望指数（HHI）评分、汉密尔顿焦虑量表（HAMA）评分、汉密尔顿抑郁量表（HAMD）评分、肝功能、视觉模拟量表（VAS）评分）,并记录术后胃肠功能恢复时间及干预期间并发症发生情况。结果干预后,观察组运动依从性各维度及总分、GSES评分、HHI评分均高于对照组,HAMD评分、HAMA评分、VAS评分均低于对照组,肠鸣音恢复时间和肛门排气时间均短于对照组,差异均有统计学意义（P<0.05）。两组并发症发生率差异无统计学意义（P>0.05）。结论基于计划行为理论结合肝胆康复操的运动训练可有效提升腹腔镜下肝癌切除术患者术后运动依从性、自我效能与希望水平,缓解负面情绪和疼痛,促进胃肠功能恢复。4周随访期内并发症发生率未观察到显著差异,提示短期应用安全性良好。该方案对术后康复具有积极意义,但长期安全性及临床获益尚需进一步验证。

关键词: 肝癌, 计划行为理论, 肝胆康复操, 术后康复, 运动依从性, 自我效能

Abstract: Objective To investigate the effects of planned behavior theory （TPB）-based exercise training combined with liver-gallbladder rehabilitation exercises on postoperative recovery in patients undergoing laparoscopic hepatectomy for hepatocellular carcinoma. Methods A total of 69 patients who underwent laparoscopic hepatectomy at a tertiary hospital in Guangdong between October 2021 and July 2023 were enrolled and randomly assigned using a random number table to an observation group （n=35） or a control group （n=34）. The control group received routine postoperative rehabilitation care, while the observation group received additional structured TPB-based exercise training combined with liver-gallbladder rehabilitation exercises. The intervention lasted 4 weeks. Primary outcomes （exercise adherence and General Self-Efficacy Scale （GSES） score） and secondary outcomes （Herth Hope Index, HHI）, Hamilton Anxiety Rating Scale （HAMA） score, Hamilton Depression Rating Scale （HAMD） score, liver function, and Visual Analogue Scale （VAS） pain score） were assessed before and 4 weeks after the intervention. Postoperative gastrointestinal recovery times and incidence of complications during the intervention period were also recorded. Results After the intervention, the observation group demonstrated significantly higher exercise adherence scores （all dimension scores and the total score）, GSES scores, and HHI scores, and significantly lower HAMD, HAMA, and VAS scores, as well as shorter bowel sound recovery and flatus time than the control group （P<0.05）. No significant between group difference was found in complication rate （P>0.05）. Conclusion TPB-based exercise training combined with liver-gallbladder rehabilitation exercises effectively improves exercise adherence, self-efficacy, and hope levels, alleviates negative emotions and pain, and promotes gastrointestinal recovery in patients after laparoscopic hepatectomy for hepatocellular carcinoma. No significant difference in complication rates was observed during the 4 week follow up period, suggesting good short term safety. This regimen has positive implications for postoperative rehabilitation; however, its long term safety and clinical benefits require further evaluation.

Key words: hepatocellular carcinoma, theory of planned behavior, liver-gallbladder rehabilitation exercises, postoperative recovery, exercise adherence, self-efficacy

中图分类号:

潘银珍, 林慕贞, 马靖. 基于计划行为理论结合肝胆康复操的运动训练对腹腔镜下肝癌切除术患者术后康复的影响[J]. 岭南现代临床外科, 2026, 26(03): 161-166.

PAN Yinzhen, LIN Muzhen, MA Jing. Effect of planned behavior theory-based exercise training combined with liver-gallbladder rehabilitation exercises on postoperative recovery in patients undergoing laparoscopic hepatectomy for hepatocellular carcinoma[J]. Lingnan Modern Clinics In Surgery, 2026, 26(03): 161-166.

参考文献

[1] 曹毛毛, 李贺, 孙殿钦, 等. 全球肝癌2020年流行病学现状[J]. 中华肿瘤防治杂志, 2022, 29(5): 322-328.
[2] 袁桃花, 范威伟, 胡光玲. 放松训练联合有氧运动对乳腺癌患者心理调适、癌因性疲乏及睡眠质量的影响[J]. 广东医学, 2020, 41(13): 1373-1377.
[3] 郭锐, 叶军明, 许厚仁, 等. 控制性低中心静脉压对腹腔镜肝癌切除术患者中心静脉血氧饱和度和乳酸的影响[J]. 临床麻醉学杂志, 2022, 38(5): 458-461.
[4] 李建军, 郑婧. 肺康复训练联合个体化营养干预对非小细胞肺癌患者术后康复的影响[J]. 重庆医学, 2023, 52(10): 1515-1519.
[5] Bray F, Laversanne M, Sung H, et al.Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3): 229-263.
[6] He YF, Liu YM, Ren BN, et al.Burden, trends and projections of liver cancer in China and G20 countries: a comparative study based on the global burden of disease database 2021[J]. Front Public Health, 2025, 13: 1668750.
[7] Zhan Z, Chen B, Huang R, et al.Long-term trends and future projections of liver cancer burden in China from 1990 to 2030[J]. Sci Rep, 2025, 15(1): 13120.
[8] Scherr J, Wolfarth B, Christle JW, et al.Associations between Borg's rating of perceived exertion and physiological measures of exercise intensity[J]. Eur J Appl Physiol, 2013, 113(1): 147-155.
[9] Irlbeck T, Zwißler B, Bauer A.[ASA classification : Transition in the course of time and depiction in the literature] [J]. Anaesthesist, 2017, 66(1): 5-10.
[10] 中华人民共和国卫生和计划生育委员会医政医管局. 原发性肝癌诊疗规范(2017年版)[J]. 中华消化外科杂志, 2017, 16(7): 635-647.
[11] 吴瑶, 林燕铭, 郭恺, 等. 基于计划行为理论的北京市社区2型糖尿病患者服药依从性影响因素研究[J]. 中国全科医学, 2021, 24(34): 4398-4403.
[12] 戚龙菊, 王佳慧, 孙泽升, 等. 有氧运动调节肝癌患者MAGED1水平、炎症反应及脂代谢[J]. 免疫学杂志, 2021, 37(7): 618-623.
[13] 何佳枫, 戚龙菊, 余静, 等. 居家有氧运动对肝癌肝动脉化疗栓塞术患者症状群的干预研究[J]. 中国康复医学杂志, 2022, 37(4): 470-475.
[14] Turner RR, Steed L, Quirk H, et al. Interventions for promoting habitual exercise in people living with and beyond cancer[J]. Cochrane Database Syst Rev, 2018, 9(9): CD010192.
[15] Bosnjak M, Ajzen I, Schmidt P.The Theory of Planned Behavior: Selected Recent Advances and Applications[J]. Eur J Psychol, 2020, 16(3): 352-356.
[16] 高小莲, 郑文清, 肖明中, 等. 基于计划行为理论的中青年肥胖性非酒精性脂肪性肝病患者中医健康管理行为意向的结构方程模型分析[J]. 中国全科医学, 2019, 22(35): 4362-4369.
[17] Husebø AML, Dyrstad SM, Søreide JA, et al.Predicting exercise adherence in cancer patients and survivors: a systematic review and meta-analysis of motivational and behavioural factors[J]. J Clin Nurs, 2013, 22(1-2): 4-21.
[18] Rodrigues B, Encantado J, Franco S, et al.Psychosocial correlates of physical activity in cancer survivors: a systematic review and meta-analysis[J]. J Cancer Surviv, 2025, 19(4): 1385-1402.
[19] 翁桂珍. 胃癌相关性疲乏患者运动处方依从性的调查研究[D]. 福建医科大学, 2014.
[20] Luszczynska A, Scholz U, Schwarzer R.The general self-efficacy scale: multicultural validation studies[J]. J Psychol, 2005, 139(5): 439-457.
[21] Chan KS, Li HC, Chan SW, et al.Herth hope index: psychometric testing of the Chinese version[J]. J Adv Nurs, 2012, 68(9): 2079-2085.
[22] Fava GA, Kellner R, Munari F, et al.The Hamilton Depression Rating Scale in normals and depressives[J]. Acta Psychiatr Scand, 1982, 66(1): 26-32.
[23] Bruss GS, Gruenberg AM, Goldstein RD, et al.Hamilton Anxiety Rating Scale Interview guide: joint interview and test-retest methods for interrater reliability[J]. Psychiatry Res, 1994, 53(2): 191-202.
[24] Kane RL, Bershadsky B, Rockwood T, et al.Visual Analog Scale pain reporting was standardized[J]. J Clin Epidemiol, 2005, 58(6): 618-623.
[25] 戚龙菊, 徐凤霞, 蒋逢辰, 等. 计划行为理论在围介入期肝癌患者居家运动锻炼中的应用[J]. 南通大学学报(医学版), 2023, 43(2): 174-177.
[26] 柳书悦, 何凤英, 陈梅先, 等. 自我效能在肝癌术后患者恐惧疾病进展与焦虑抑郁间的中介效应[J]. 护理管理杂志, 2021, 21(2): 91-94.
[27] Zhang C, Lu N, Qin S, et al.Theoretical Explanation of Upper Limb Functional Exercise and Its Maintenance in Postoperative Patients With Breast Cancer[J]. Front Psychol, 2022, 12: 794777.
[28] 严芳. 早期康复锻炼联合疼痛护理在肝癌术后患者中的应用效果分析[J]. 中国社区医师, 2020, 36(28): 170-171.
[29] Kuo CC, Wang CC, Chang WL, et al.Clinical Effects of Baduanjin Qigong Exercise on Cancer Patients: A Systematic Review and Meta-Analysis on Randomized Controlled Trials[J]. Evid Based Complement Alternat Med, 2021, 2021: 6651238.
[30] Liu H, Liu S, Xiong L, et al.Efficacy of Baduanjin for treatment of fatigue: A systematic review and meta-analysis of randomized controlled trials[J]. Medicine (Baltimore), 2023, 102(32): e34707.