胸腹腔镜与传统Ivor-Lewis手术对早中期食管癌患者术后生活质量的影响

A Comparative Study of Quality of Life After Minimally Invasive and Traditional Ivor-Lewis Oesophagectomy

[目的]比较胸腹腔镜与传统Ivor-Lewis手术对Ⅰ、Ⅱ期食管癌患者术后近期生活质量的影响。[方法]收集2014年2月至2014年6月浙江省肿瘤医院胸外科手术的Ⅰ、Ⅱ期食管癌患者112例,其中胸腹腔镜食管癌根治术53例,传统Ivor-Lewis术式59例。采用欧洲癌症研究与治疗组织开发的EORTC QLQ-C30 V3.0中文版及EORTC QLQ-OES18中文版评价患者术前、术后1月、6月及12月生活质量。[结果]术后1月两组总体健康状况和功能领域评分相比术前基线显著性下降(P<0.05),两组相比,总体健康状况(37.25±15.03 vs 27.34±12.38,P=0.000),躯体功能(49.93±8.04 vs 36.73±13.34,P=0.000),角色功能(38.89±10.36 vs27.78±14.88,P=0.000),胸腹腔镜组评分优于Ivor-Lewis组。在症状领域,术后1个月两组症状(疲劳、疼痛、失眠、食欲下降、腹泻、恶心呕吐)评分比术前基线显著性升高,两组相比,疲劳症状(50.33±14.80 vs 58.87±18.30,P=0.009),疼痛症状(54.58±16.01 vs 71.64±14.42,P=0.009),返流症状(33.66±15.45 vs 46.78±15.8,P=0.000),胸腹腔镜组评分优于Ivor-Lewis组。术后6月及12月,患者总体健康状况、功能领域及症状领域较术前恢复趋势,其中疲劳、疼痛、返流症状在术后1月、6月、12月胸腹腔镜组均优于Ivor-Lewis组(P<0.05)。[结论]胸腹腔镜食管癌根治术患者总体术后近期生活质量优于Ivor-Lewis手术。

[Purpose] To compare the short-term quality of life（QOL） between minimally invasive and traditional Ivor-Lewis oesophagectomy for stage Ⅰ and stage Ⅱ esophageal cancer. [Methods]Participants comprised 112 patients with stage Ⅰ and stage Ⅱ esophageal cancer from Feb.2014 to Jun.2014 in Zhejiang Cancer Hospital,59 patients underwent traditional Ivor-Lewis esophagectomy,and the other of them underwent minimally invasive oesophagectomy. The questionnaires（EORTC QLQ C-30 and EORTC QLQ OES-18） were applied to assess the quality of life of the patients before and 1,6,12 months after operation. [Results] The overall quality of life and functional scales were found declined in both groups 1 month after surgery（P 0.05）. Patients underwent minimally invasive oesophagectomy indicated,significantly better scores in the functional scales and global quality of life 1 month after surgery,when compared with traditional Ivor-Lewis oesophagectomy,better global quality of life（37.25±15.03 vs. 27.34±12.38,P=0.000）,better physical function（49.93±8.04 vs. 36.73±13.34,P=0.000）,better role function（38.89±10.36 vs. 27.78±14.88,P=0.000） was found. And The scores of symptom scales（fatigue,pain,reflux,dyspnea,appetite loss and dry mouth） were markedly increased 1 month after surgery（P〈0.05）. Minimally invasive oesophagectomy showed lower scores when compared with traditional Ivor-Lewis oesophagectomy,less fatigue（50.33±14.80 vs. 58.87±18.30,P=0.009）,less pain（54.58±16.01 vs. 71.64±14.42,P=0.009）,less reflux（33.66±15.45 vs. 46.78±15.8,P=0.000）,and the advantage last for 12 months after surgery. The overall quality of life,functional scales and symptom scales were restored at 6 months or 12 months after surgery. [Conclusions] Minimally invasive esophagectomy provide a generally better short-term QOL for patients with esophageal cancer compared with traditional Ivor-Lewis oesophagectomy.