近端胃切除术与全胃切除术对食管胃结合部腺癌患者生活质量的影响

Influence on Quality of Life after Proximal Gastrectomy and Total Gastrectomy for Adenocarcinoma of Esophagogastric Junction

目的探索食管胃结合部腺癌(AEG)患者行经腹近端胃切除与全胃切除术后生活质量的差异。方法选择2011年1月至2012年3月期间于四川大学华西医院胃肠外科中心行经腹近端胃切除术(近端胃切除组)或全胃切除术(全胃切除组)的85例AEG患者作为研究对象,于术后12个月,采用生活质量核心问卷30(QLQ-C30)和胃癌特异性评价量表(QLQ-STO22)测量其生活质量,并进行组间比较。结果 2组患者的年龄、性别等临床病理特征的差异均无统计学意义(P>0.05),具有可比性。近端胃切除组患者在饮食受限、腹泻及气促方面的得分低于全胃切除组(P<0.05),而在味觉改变和反流方面的得分高于全胃切除组患者(P<0.05)。2组患者的其他项目得分比较差异均无统计学意义(P>0.05)。结论Ⅱ型和Ⅲ型AEG患者行近端胃切除+管状胃重建和全胃切除+Roux-en-Y吻合术后都有不同程度的并发症发生。近端胃切除术在饮食受限、腹泻以及气促方面的效果更优;而全胃切除术在反流和味觉改变方面的效果更优。

Objective To investigate the differences of postoperative quality of life （QOL） between proximal gas- trectomy （PG） and total gastrectomy （TG） in patients with adenocarcinoma of esophagogastric junction （AEG）. Methods Eighty five patients with AEG （Siewert type Ⅱ or Ⅲ） who were underwent PG or TG surgery between Jan. 2011 and Mar. 2012 at West China Hospital of Sichuan University were enrolled, to measure the QOL by using the Chinese version of quality of life questionnaire core-30 （QLQ-C30） and the site-specific module for gastric cancer （QLQ-STO22） which were drawed up by the European Organization for Research and Treatment of Cancer （EORTC） in 12 months after operation. Results There were no any difference of clinicopathological features between patients in 2 groups （P〉 0. 05）, such as age, gender, and so on. The scores of eating restriction, diarrhea, and dyspnea in PG group were lower than those of TG group （P〈0. 05）, but scores of reflux and taste change were higher （P〈0. 05）, no other significant differ- ence was found between the patients of 2 groups （P〉 0. 05）. Conclusion Both of PG ＋ gastric tube reconstruction and TG＋Roux-en-Y anastomosis in treatment of patients with Siewert type Ⅱ or Ⅲ AEG may lead to complications, but patients who underwent former surgery have better situation in eating restriction, diarrhea, and dyspnea, and patients who underwent later surgery have better situation in reflux and taste change.