Jiang’s吻合对食管癌切除患者术后生活质量的影响

Study on Health-related Quality of Life in Patients with Jiang’s Gastroesophageal Anastomosis after Oncologic Esophagectomy

目的比较管状胃代食管的食管癌切除术Jiang’s胃-食管吻合与传统端侧吻合对患者术后生活质量的影响。方法选取我科2012年10月至2016年8月行手术治疗的食管癌419例,根据食管-胃吻合方式不同分为2组:Jiang’s吻合组223例,传统端侧吻合组196例。采用EORTC-QLQ-C30与QLQ-OES18量表评估术后1、3、6、12、24月的生活质量。结果 EORTC-QLQ-C30与QLQ-OES1量表共25个维度和项目。患者生活质量在术后第1月明显下降,第6月时恢复较快;术后第1、2年生活质量基本波动在较小范围内。术后第1月,Jiang’s吻合组反流、咳嗽两个维度的得分优于端侧吻合组(P=0.023,P=0.010);第3月Jiang’s吻合组反流、咳嗽两个维度的得分优于端侧吻合组(P=0.004,P=0.013);术后6月时,Jiang’s吻合组情绪功能、反流、咳嗽三个维度的得分优于端侧吻合组(P=0.013,P=0.014,P=0.043)。术后1年Jiang’s吻合组恶心与呕吐、情绪功能、反流三个维度的得分优于端侧吻合组(P=0.023,P=0.004,P=0.021)。术后2年Jiang’s吻合组反流维度的得分仍优于端侧吻合组(P=0.020)。其他维度和项目差异在随访期间没有统计学意义。结论与传统端侧吻合相比较,Jiang’s吻合安全可行,有效减少术后主要并发症,提高患者术后生活质量,值得进一步推广。

Objective To compare the difference of health-related quality of life after oncologic esophagectomy between the patients using Jiang’s gastroesophageal anastomosis and traditional end-to-end gastroesophageal anastomosis. Methods A total of 419 patients(223 in Jiang’s anastomosis group, and 196 in end-to-end anastomosis group) underwent minimal invasive esophagectomy with cervical anastomosis from October 2012 to August 2016. All patients received radical esophageal cancer resection and cervical anastomosis. EORTC-QLQ-C30 and QLQ-OES18 were used to assess the health-related quality of life at the 1 st, 3 rd, 6 th, 12 th, 24 th month after esophagectomy. Results There were 25 dimensions and items in EORTC-QLQ-C30 and QLQ-OES18. The postoperative quality of life decreased obviously at the 1 st month and then recovered obviously at the 6 th month after the surgery, and it ranged small at the 12 th and 24 th month. Compared with end-to-end anastomosis group, Jiang’s anastomosis group had less reflux and less cough at the 1 st month(P=0.023, P=0.010) and the 3 rd month(P=0.004, P=0.013), then had better emotional function, less reflux and less cough at the 6 th month(P=0.013, P=0.014, P=0.043), better emotional function, less nausea,and less reflux at the 12 th month(P=0.004, P=0.023, P=0.021), as well as less reflux at the 24 th month(P=0.020). There was no significant difference in other dimensions and items between the two groups during the follow-up period. Conclusion Jiang’s anastomosis is safe and feasible, and could improve the postoperative quality of life of the patients with esophagectomy. It is worth to further application in clinical practice.