不同手术方式对贲门癌患者远期生活质量及营养状况的影响

Impact of different surgical procedures on the long-term quality of life and nutritional status after gastrectomy in patients with cardia cancer

目的探讨贲门癌患者行根治性近端胃大部切除食管残胃端侧吻合、根治性全胃切除Roux-en-Y吻合及根治性全胃切除空肠间置法吻合术后3年的生活质量及营养状况。方法回顾性分析医院胃肠外科收治的108例贲门癌患者的临床资料,其中行根治性近端胃大部切除食管残胃端侧吻合术30例(近端胃大部组),行根治性全胃切除食道空肠Roux-en-Y吻合49例(Roux-en-Y组),行根治性全胃切除空肠间置法吻合29例(空肠间置组)。术后3年进行胃癌患者生活质量问卷(QLQ-ST022)调查,同时检测患者体重、血红蛋白(Hb)、血白蛋白(ALB),前白蛋白(PAB)、转铁蛋白(TF)。并对三组患者资料进行比较。结果胃癌患者生活质量问卷评分吞咽困难、胃部疼痛、饮食受限、焦虑、口干、味觉、身体外观等项目三组间差异无统计学意义(P>0.05),近端胃大部组术后呃逆评分(46.07±12.94)高于Roux-enY组(26.59±10.31)及空肠间置组(29±8.34),有显著性差异(f=22.339,P<0.05)。三组患者在术后3年体重、血红蛋白、白蛋白、前白蛋白、及转铁蛋白各项营养指标差异无统计学意义(P>0.05)。结论近端胃大部切除术后患者存在较为严重的呃逆及返流,影响生活质量。保留远端残胃及空肠间置并不能显著改善患者的营养状况。根治性全胃切除Roux-en-Y吻合操作相对简便,术后长期生活质量及营养状况较好,是目前贲门癌患者较为合适的手术方式。

Objective To discuss the long-term quality of life and nutrition status in patients with cardiac carcinoma. Methods 108 patients underwent operation at the auther＇s hospital from January 2009 to December 2009. Among them,30 patients were underwent proximal gastrectomy,49 patients were underwent total gastrectomy Roux-en-Y gastrojejunostomy and 29 patients were underwent total gastrectomy interpositional jejunu. The differences among the three groups of the quality of life（Using gastric cancer QLQ-ST022,including the numerical of difficulty swallowing, the pain of the stomach, hiccups, limited diet, anxiety, dry mouth, taste, and physical appearance） and nutrition status （including weight,hemoglobin,albumin, prealbumin and transferrin） were observed. Results There was no statistic difference among three groups on the numerical of difficulty swallowing, the pain of the stomach, limited diet, anxiety, dry mouth, taste, and physical appearance）, （F=0.281,0.365,2.153,1.091,0.009,0.362 and 0.074,P〉0.05） and nutrition sta- tus （weight,hemoglobin,albumin, prealbumin and transferrin）, （F= 1. 324,1.791,1.630,0. 755 and 1.683, P〉0.05）. The numerical of hiccups of group of proximal gastrectomy （46.07±12.94）was much higher than that of the other two groups （26.59±10.31,29±8.34） ,（F=22.339,P〈0.05）. Conclusions After proximal gastrectomy, the patients suffer serious hiccups and reflux, lower the quality of life. Retained distal residual stomach and interpositional jejunu did not significantly improve the nutritional status of patients. Total gastrectomy Roux-en-Y gastrojejunostomy is easy and simple to handle, postoperative the long-term quality of life and the nutrition is good.