胸段食管癌及食管胃交界部癌根治术后患者生存质量影响因素的研究

Factors Affecting the Quality of Life of Patients with Esophageal and Gastroesophageal Junction Carcinoma

目的:对行食管及食管胃交界部癌根治术的372例生存患者进行随访,分析不同因素对生存质量的影响,以有利于采取相应的综合性干预措施。方法:通过一般情况问卷、欧洲癌症研究和治疗组织研制的生存质量核心问卷QLQ-C30、食管癌专用量表OES-18电话、信访患者。选取性别、年龄、户籍等11个变量,采用t检验或单因素方差分析比较各组患者在生存质量得分方面的差异;多元线性回归分析这些因素对生存质量的影响。结果:不同性别、年龄对患者生存质量的影响不同;非自费患者(包括医保、公费、合作医疗等)在社会功能方面的困扰大于自费患者;性格外向患者在躯体、情感、认知、社会、角色功能、总体健康状况方面均优于性格内向患者;患者在知情情况下,角色功能优于不知情的情况,呼吸功能受到困扰较小;精神良好患者在情感功能、呼吸功能、食欲方面较其它两组表现较好,精神较差患者在躯体功能、疼痛、睡眠、便秘方面表现较差;术后1～2年患者的认知功能较好,腹泻的困扰较其它两组明显,术后5年以上的患者角色功能、总体健康状况较好。结论:不同因素影响食管及食管胃交界部癌患者的不同领域,临床上应该采取综合性措施以改善患者的生存质量。

Objective： We retrospectively investigated the quality of life of patients with esophageal cancer （EC） or gastroesophageal junction （GEJ） carcinoma treated with surgery in our hospital between 1996 and 2005. Factors influencing QOL of patients with EC or GEJ were evaluated. Methods： A total of 372 EC or GEJ cases were randomly selected. The demographic and medical data were collected and analyzed using the general information investigation forms QLQ-C30 （3.0） and OES-18. Results： There was a significant difference in physical function abilities between males and females （P〈0.05）. Patients younger than 50 had worse cognitive functioning and were more susceptive to fatigue, while patients older than 60 were more commonly faced with economic issues, dyspnoea, and diarrhea. Patients having medical inssurance had better social functioning and suffered fewer economic difficulties and less pain. Extroverted patients fared better than intro- verts in terms of physical, emotional, cognitive, social functioning, role functioning, and general QOL. Introverted patients suffered more fatigue, insomnia, economic difficulties, dyspnoea, diarrhea, and anorexia. Patients who were educated about the disease had better role functioning and less dyspnoea. Patients with good men- tal status had the best emotional status, less dyspnoea, and better appetite than those in a moderate or poor mental state. Patients with a poor mental status suffered more from poor physical function, pain, sleep issues, constipation, nausea and vomiting. There were significant differences in cognitive functioning, role functioning, and general QOL in the 1-2-year postoperative group, the 2-5-year postoperative group and the 5-plus-yearpostoperative group （P〈0.05）. Conclusion： Tumor location, clinical stage and infiltrating depth are factors impacting diverse domains of QOL.