食管胃胸内吻合联合肺减容术后患者生活质量的评价

Quality of life of patients after esophagogastrostomy combined with lung volume reduction surgery

目的评价食管胃胸内吻合联合肺减容手术(LVRS)对食管贲门癌合并重度肺气肿患者生活质量的影响。方法1998年6月至2004年3月,选取食管贲门癌合并重度肺气肿患者18例,其中食管癌15例、贲门癌3例,施行食管贲门切除、食管胃胸腔内吻合术,同时用直线形缝合切割器行同侧LVRS,根据术前影像学、术中所见及胸胃大小决定肺切除量。用SF36生活质量问卷表评价患者术前及术后3个月、6个月和12个月的生活质量,并进行比较。结果肺切除量约为单侧肺容量的25%～30%,切除重量为62.2g±9.6g。无手术死亡,术后平均住院19.7d±4.8d,恢复顺利。术后SF36生活质量表中所有指标均明显改善(P<0.05或P<0.01)。结论食管胃胸内吻合联合LVRS可显著地改善食管贲门癌合并重度肺气肿患者的生活质量。

Objective To evaluate the effect of lung volume reduction surgery (LVRS) combined with esophagogastrostomy in thorax on quality of life of the patients with severe emphysema combined with esophageal or cardiac carcinoma. Methods Eighteen patients suffering from esophageal or cardiac carcinomas and severe emphysema with severely impaired respiratory function and low quality of life underwent resection of carcinoma and esophagogastrostomy in thorax. And then, same side LVRS was performed using TLC75 stapler. All staple lines were buttressed with bovine pericardial strips. Quality of life was evaluated before operation and every 3 months up to one year postoperatively by using the Short-form 36 (SF-36) health questionnaire. Results The volumes of resected pulmonary tissues, weighing ^(62.2±9.6) g , accounted for 25%～30% of the total volume of the same side lung parenchyma. All the cases went through successfully the perioperative period without hospital mortality. Postoperative hospital stay averaged 19.7±4.8 days (15 to 23 days). All of the functions included in the SF-36 were improved (P<0.01 or ~P< 0.05). Conclusion Esophagogastrostomy in thorax combined with LVRS significantly benefits the patients with severe emphysema and esophageal or cardiac carcinoma in terms of long-term quality of life.