两种消化道重建方式对食管癌病人围手术期及术后生活质量影响比较

EFFECT OF TWO METHODS OF DIGESTIVE TRACT RECONSTRUCTION ON PERIOPERATIVE AND POSTOPERATIVE QUALITY OF LIFE IN PATIENTS WITH ESOPHAGEAL CANCER:A COMPARATIVE ANALYSIS

目的比较两种消化道重建方式对食管癌病人围手术期及术后生活质量的影响。方法选取2009年7月—2012年7月于我科行手术治疗的食管癌病人105例,根据手术方式分为管状胃组57例、全胃代食管组48例,比较两组病人围手术期手术并发症发生率、术后6个月~3年病人的生存率及生活质量。结果管状胃组病人围手术期手术并发症发生率(33.33%)低于全胃代食管组病人(56.25%),差异具有统计学意义(χ~2=5.559,P<0.05)。管状胃组病人术后6个月、18个月、3年时的QLQ-C30评分均高于全胃代食管组病人,差异具有统计学意义(F=33.084,P<0.05)。管状胃组病人术后6个月、18个月、3年时的体力状况、恶心、吞咽困难、泛酸、呼吸困难评分均高于全胃代食管组病人,差异具有统计学意义(t=2.501~5.514,P<0.05)。管状胃组病人术后1、2、3年的累积生存率呈高于全胃代食管组病人的趋势,但差异无统计学意义(P>0.05)。结论管状胃与全胃代食管消化道重建方式对病人的预后影响差异不明显,但行管状胃代食管术病人的生活质量较高,具有一定的优势。

Objective To investigate and compare the effect of two methods of digestive tract reconstruction on perioperative and postoperative quality of life in patients with esophageal cancer. Methods A total of 105 patients with esophageal cancer who underwent surgical treatment in our department from July 2009 to July 2012 were enrolled,and according to the surgical procedure,these patients were divided into tubular stomach group with 57 patients and total stomach group with 48 patients.The two groups were compared in terms of the incidence rate of perioperative complications,survival rate from 6 months to 3 years after surgery,and quality of life. Results The tubular stomach group had a significantly lower incidence rate of perioperative complications than the total stomach group（33.33% vs 56.25%,χ~2=5.559,P0.05）.Compared with the total stomach group,the tubular stomach group had significantly higher QLQ-C30 scores at 6 months,18 months,and 3 years after surgery（F=33.084,P0.05）,and had significantly higher scores of physical condition,nausea,dysphagia,acid regurgitation,and dyspnea at 6 months,18 months,and 3 years after surgery（t=2.501-5.514,P0.05）.The tubular stomach group had higher 1-,2-,and 3-year cumulative survival rates than the total stomach group（P0.05）. Conclusion There is no significant difference in the effect on patient prognosis between these two methods of digestive tract reconstruction,but patients with tubular stomach tend to have higher quality of life,suggesting that tubular stomach reconstruction has certain advantages over esophageal reconstruction by total stomach.