不同宽度管状胃对食管癌切除术后患者生活质量的影响:一项倾向配比研究

Evaluation on the quality of life in patients with different widths of gastric conduit reconstruction after esophagectomy:a propensity score matched comparison

目的:探讨细管状胃与宽管状胃对食管癌患者术后生活质量的差异。方法:回顾性分析2018年1月至2019年12月复旦大学附属中山医院胸外科收治的行微创食管癌切除术的520例临床早期食管癌患者的病例资料,分为宽(5 cm宽度)管状胃组(n=260)和细(3 cm宽度)管状胃组(n=260),分析其围手术期外科效果指标。采用欧洲癌症治疗研究组织(EORTC)生活质量评分量表(QLQ C-30和OES-18量表)对2组患者的术前和术后3、6、9、12个月的生活质量进行评价,并采用重复测量方差分析进行比较。结果:2组患者在年龄、性别、体质量指数、合并疾病指数、麻醉风险分级、肿瘤部位和术后病理分期等临床特征方面的差异均无统计学意义,在出血量、术后住院天数、总体并发症发生率方面的差异均无统计学意义。细管状胃组的相关手术耗材费用较高[(0.79±0.04)万元vs(0.58±0.05)万元,P=0.000]。2组患者的生活质量各项指标在术前基线水平的差异均无统计学意义,而在术后有不同程度的恶化,但均随时间延长而逐渐改善。重复测量方差分析结果显示,除时间效应外,细管状胃组术后在整体状况评分、呼吸不适、反流症状、咳嗽等4项指标方面明显优于宽管状胃组,差异有统计学意义(P<0.05)。结论:采用细管状胃的食管癌患者术后生活质量更好。

Objective:To explore the difference of short-term quality of life(QoL)in patients with different width of gastric conduit reconstruction after esophagectomy.Methods:A total of 520 patients who underwent minimally invasive three-incision esophagectomy from January 2018 to December 2019 were included in this study.They were divided into two groups:wide(5 cm)tubular stomach group(n=260)and narrow(3 cm)tubular stomach group(n=260),and the perioperative surgical effect indexes of the two groups were analyzed.The questionnaire QLQ C-30 together with OES-18,developed by the European Organization for Research on Treatment of Cancer were applied to evaluate the QoL of the patients before and 3,6,9,12 months after surgery.The repeated ANOVA test was used for the statistical analysis.Results:The differences in patient demographics after matching such as age,sex,body mass index,comorbidity index,anesthetic risk grade,tumor location,and pTNM stage between the two groups were not statistically significant.No statistical difference was founded on the peri-operative outcomes,such as blood loss,postoperative hospital stay,or morbidity between the two groups.However,the cost of surgical materials was higher in the narrow tubular stomach group([7.9±0.4]vs[5.8±0.5]thousand yuan,P=0.000).The QoL scores in baseline were comparable and deteriorated after surgery,but improved gradually with the duration of time.The result of repeated ANOVA analysis revealed that,apart from time effect,the patients in the narrow tubular stomach group had better scores on overall physical condition dyspnoea symptom,coughing symptom,reflux symptom than the wide tubular stomach group(P<0.05).Conclusions:The narrow gastric conduit reconstruction seems to have better QoL than conventional wide gastric conduit reconstruction.