摘要
目的对比食管胃交界部癌采用不同手术方式治疗的效果,以及术后患者的生活质量,探讨合理的手术方法。方法 2007年7月至2011年10月徐州市第一人民医院收治的食管胃交界部癌患者148例,男111例,女37例,平均年龄64(47～77)岁。根据术前评估和肿瘤外侵情况不同对148例食管胃交界部癌患者分别采用不同的手术方式,并分为3组。A组:81例,行胃近端大部切除、食管胃弓下吻合术;B组:20例,行全胃切除、食管空肠吻合术;C组:47例,行胃近端大部切除、食管残胃间空肠间置术。术后观察3组患者的手术死亡率、术后并发症发生率;术后1年观察复发转移率和病死率,并且用EORTC QLQ问卷表对随访的患者进行问卷调查,进行术后生活质量评价。结果 3组患者术后并发症发生率(P=0.762)和手术死亡率(P=0.650)差异无统计学意义,术后1年3组复发转移率比较差异无统计学意义(P=0.983);术后1年3组患者的生存率均为100%。术后1年A组、C组患者躯体功能(P=0.037,0.000)和总体健康状况评分(P=0.035,0.006)明显高于B组,而A组与C组比较差异无统计学意义(P>0.05)。B组患者情绪功能评分明显低于C组(P=0.015)。A组、C组患者术后疲劳(P=0.040,0.006)、食欲丧失(P=0.045,0.025)、恶心呕吐症状评分(P=0.033,0.048)明显低于B组;A组疼痛症状评分低于C组(P=0.009),失眠症状评分高于C组(P=0.028);反流症状评分明显高于B组、C组(P=0.025,0.021)。结论食管胃交界部癌行全胃切除患者术后的生活质量较差,而行胃近端大部切除、食管残胃间空肠间置术能明显改善患者术后的生活质量,术后患者生活质量评价可能有助于手术方式的选择。
Objective To compare clinical outcomes and postoperative quality of life（QOL） of difference surgical strategies for patients with esophagogastric junction（EGJ） cancer,and investigate the best surgical strategy.Methods A total of 148 patients with EGJ cancer underwent surgical treatment in Xuzhou First People＇s Hospital from July 2007 to October 2011.There were 111 male patients and 37 female patients with an average age of 64（47-77）years.All the patients were divided into 3 groups according to different surgical strategies for them based on their respective preoperative assessment and tumor invasion degree.In group A,81 patients underwent proximal subtotal gastrectomy and subaortic gastroesophageal anastomosis.In group B,20 patients underwent total gastrectomy and esophagojejunostomy.In group C,47 patients underwent proximal subtotal gastrectomy and jejunal interposition.Postoperative mortality and morbidity were compared among the three groups.Cancer metastasis rate and 1-year survival rate were also compared among the three groups.QOL questionnaire（EORTC QLQ C-30 and tumor specific module QLQ-OES24） was used to evaluate patients＇ QOL during follow-up.Results There was no statistical difference in postoperative morbidity（P=0.762）and mortality（P=0.650）among the three groups.There was no statistical difference in cancer metastasis rate at 1 year after surgery among the three groups（P=0.983）.One-year survival rate was 100% in all the three groups.At 1 year after surgery,physical functioning score（P=0.037,0.000） and global health score（P=0.035,0.006） of group A and group C were significantly higher than those of group B,and there was no statistical difference in physical functioning score and global health score between group A and group C（P0.05）.Emotional function score of group B was significantly lower than that of group C（P=0.015）.Fatigue score（P=0.040,0.006）,anorexia（P=0.045,0.025）,nausea and vomiting symptom score（P=0.033,0.048） of group A and group C were significantly lower than those of group B.Pain score of group A was significantly lower than that of group C（P=0.009）.Insomnia score of group A was significantly higher than that of group C（P=0.028）.Reflux score of group A was significantly higher than that of group B and group C（P=0.025,P=0.021）.Conclusion Postoperative QOL in patients with EGJ cancer who undergo total gastrectomy is comparatively unsatisfactory.Proximal subtotal gastrectomy and jejunal interposition can significantly improve postoperative QOL.Postoperative QOL evaluation is helpful to choose better surgical strategies for patients with EGJ cancer.
出处
《中国胸心血管外科临床杂志》
CAS
2012年第6期629-633,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
