胸腔镜辅助与传统根治术对老年食管癌术后近期生活质量的影响

Influence of video-assisted thoracoscopic surgical esophagectomy and routine operation on recent quality of life of old patients with esophageal cancer

目的探讨胸腔镜辅助与传统食管癌根治术对Ⅰ、Ⅱ期老年食管癌患者术后近期生活质量的影响。方法收集2009年6月~2012年6月该院胸心外科收治的Ⅰ、Ⅱ期老年食管癌患者85例,将其根据手术方式不同分组：胸腔镜组45例和传统手术组40例,应用EORTC QLQ C-30和EORTC QLQ-OES18对两组患者进行了术前及手术后12个月内生活质量的评估。结果术后1周、术后1个月,两组患者的功能维度、总的生活质量维度均较术前明显下降,而症状性维度均较术前明显升高;术后3、6个月时,两组患者功能维度、总的生活质量维度均开始逐渐回升,而症状性维度则开始下降,至术后6个月时,胸腔镜组患者的功能维度、总的生活质量维度及症状性维度均已恢复术前水平,而传统手术组患者功能维度、总的生活质量维度及症状性维度仍与术前水平差异存在显著性（P〈0.05）。术后1周、1个月、3个月、6个月及12个月,传统手术组患者功能维度和总的生活质量维度评分明显较胸腔镜组患者低（P〈0.05）,而症状性维度则明显较胸腔镜组高（P〈0.05）。QLQ-OES18食管癌特有症状维度变化显示,两组患者术后吞咽困难指标和与食管癌有关疼痛症状得分均较术前明显降低,呈逐渐下降趋势,且两组患者间差异无显著性（P〉0.05）;但术后1周时,两组患者的进食呛咳、吻合口反流、味觉障碍及吞咽唾液困难程度得分均明显高于术前水平,之后逐渐下降,但胸腔镜组患者评分较低,两组之间比较,差异存在显著性（P〈0.05）。结论胸腔镜辅助食管癌根治术对改善老年食管癌患者术后近期生活质量有较好效果,明显优于传统开胸手术。

【Objective】To evaluate the impact of video-assisted thoracoscopic surgery（VATS） and routine operation on recent quality of life（QL） of old patients with esophageal cancer.【Methods】85 esophageal cancer patients in old age were classified into VATS group（n=45） and routine operation group（n=40） randomly,all patients in two groups completed the Chinese versions of the European Organization for Research and Treatment of Cancer（EORTC）Quality of Life Questionnaire（QLQ）-C30 and QLQ-OES18 before treatment and 12 months after operation.【Results】At one week,one month after operation,function MEAN score and QOL in two groups decreased significantly,symptom QL MEAN score in two groups increased significantly compared with before treatment（P 0.05）.At 3,6 month after operation,function MEAN score and QOL in two groups began increasing,symptom QL MEAN score in two groups began decreasing.At 6 month after operation,function MEAN score,QOL and symptom QL MEAN score in VATS group came back to the level of before treatment,but in routine operation group there were different significantly in function MEAN score,QOL and symptom QL MEAN score compared with before treatment（P 0.05）.At one week,1,3,6,12 month after operation,function MEAN score and QOL in routine operation group were lower than those in VATS group（P 0.05） and symptom QL MEAN score in routine operation group were higher than those in VATS group（P 0.05）.In two groups,QLQ-OES18 scales of dysphagia and pain symptoms about esophageal neoplasms decreased after surgery（P 0.05）.There were no significant differences between two groups（P 0.05）.At one week after operation,QLQ-OES18 scales of eating habits,eating refluxin and swallowing saliva difficultly in two groups increased significantly compared with before treatment（P 0.05）,after then decreased,but decreased significantly in VATS group（P 0.05）.There were significant differences between two groups（P 0.05）.【Conclusion】 VATS is of better effect on improving short term quality of life of esophageal cancer patients in old age compared with routine operation.