内镜与手术治疗对远端胃早期癌的远期生活质量及功能影响

Effects of endoscopic and surgical treatment for distal early gastric cancer on long-term quality of life and function

目的以外科手术患者为对照,对内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗远端胃早期胃癌(early gastric cancer,EGC)的远期生活质量(quality of life,QOL)及胃功能进行对比研究。方法筛选出于北京协和医院接受ESD或外科手术切除治疗的EGC患者,对术后1年以上的患者进行随诊。采用QLQ-C30,SF-36,EQ-5D和消化不良症状评定量表评价QOL;通过5 h胃排空率评价远端胃功能;采用胃镜观察吻合口是否通畅。根据切除时年龄,对胃下1/3行ESD(EP)组和远端胃大部切除(SP)组进行1∶1匹配,对比两组的QOL和胃功能。结果共纳入EP组和SP组患者各25例。经QLQ-C30测定,认知功能的得分分值分别为EP组83.3(83.3,83.3),SP组83.3(83.3,100.0)(P=0.056);两组症状(疲倦、恶心呕吐、疼痛、气促、失眠、食欲丧失、便秘、腹泻和经济困难)阳性患者比例差异无统计学意义。两组EQ-5D健康状况和SF-36的得分分值差异无统计学意义。经消化不良症状评定量表测定,EP组有烧灼症状的患者占56.0%,而SP组仅28.0%患者有此症状(P=0.054);SP组有恶心症状的患者占20.0%,而EP组仅4.0%患者有此症状(P=0.084)。胃排空结果显示EP组5 h胃排空率异常者高达31.8%,而SP组没有排空异常(P=0.003)。胃镜结果示,EP组1例患者存在幽门管狭窄,但5 h胃排空率正常;Sp组吻合口均通畅。结论ESD和外科手术治疗远端胃EGC,对患者QOL的远期影响大致相同。远端胃ESD后的远期胃排空功能有所下降。

Objective To study the effects of endoscopic submucosal dissection(ESD)on long-term quality of life(QOL)and gastric function of patients with distal early gastric cancer(EGC),compared with those of surgery.Methods Patients with EGC who received ESD or surgical resection in Peking Union Medical College Hospital over 1 year ago were selected to be followed up.QLQ-C30,SF-36,EQ-5D and dyspeptic symptom rating scale were used to evaluate QOL.Five-hour gastric emptying rate was used to evaluate distal gastric function.Electronic gastroscopy was used to observe whether the anastomotic stoma was stenotic.According to the age at resection,1 to 1 matching was performed between the distal 1/3 gastric ESD(EP)group and the distal subtotal gastrectomy(SP)group,and then the QOL and gastric function between the two groups were compared.Results Twenty-five patients were included in group EP and group SP respectively.According to QLQ-C30,the scores of cognitive function were 83.3(83.3,83.3)in group EP and 83.3(83.3,100.0)in group SP(P=0.056).The proportion of patients with symptoms(fatigue,nausea and vomiting,pain,dyspnea,insomnia,appetite loss,constipation,diarrhea and financial difficulties)between the two groups were not statistically different.There was no statistical difference in the scores of EQ-5D and SF-36 between the two groups.According to dyspeptic symptom rating scale,56.0%patients in group EPhad burning sensation,but only 28.0%in group SP had this symptom(P=0.054).20.0%of patients in group SPreported nausea,while only 4.0%in group EP had this symptom(P=0.084).Gastric emptying results showed that the proportion of patients with abnormal 5-hour gastric emptying rate was 31.8%in group EP,while there was no abnormal emptying in group SP(P=0.003).Gastroscopy results showed that one patient in group EP had pyloric stenosis,but 5-hour gastric emptying rate was normal.All anastomotic stomas in group Sp were unobstructed.Conclusion ESD and surgical resection for distal EGC show similar long-term effects on QOL of patients.But the long-term gastric emptying function may decrease after distal gastric ESD.