进展期Siewert Ⅱ型食管胃结合部腺癌三种不同术式治疗后患者生活质量的比较

The comparison of the quality of life underwent three different surgical procedures for advanced Siewert type Ⅱ adenocarcinomas of the esophagogastric junction

目的:对进展期SiewertⅡ型食管胃结合部腺癌三种不同术式治疗后患者生活质量进行比较,为优化进展期SiewertⅡ型食管胃结合部腺癌患者的手术治疗提供理论依据。方法:选取西安交通大学第一附属医院2015年10月至2017年10月收治的进展期SiewertⅡ型食管胃结合部腺癌患者105例。根据术式将患者分为三组,每组35例,分为全胃切除组(A组)、传统近端胃切除组(B组)和双通道吻合组(C组)。采用癌症患者总体生活质量量表(quality of life questionnaire core-30,QLQ-C30)、食管胃结合部癌专用量表(quality oflife questionnaire oesophagogastric-25,QLQ-OG25)进行量化后,比较上述三组患者术后半年和1年的生活质量差异。结果:QLQ-C30:术后半年:C组在总体生活质量、躯体功能、疲乏及呼吸困难等方面均优于A组和B组(P<0.05),情绪功能优于A组(P<0.05);A组在角色功能、疲乏、腹泻等方面均差于B组和C组(P<0.05);B组的食欲减退症状重于A组及C组(P<0.05)。术后1年:C组总体生活质量、躯体功能及情绪功能等方面均优于A组及B组(P<0.05),角色功能优于A组(P<0.05);A组疲乏与腹泻症状均重于B组和C组(P<0.05);B组食欲减退症状重于A组和C组(P<0.05)。QLQ-OG25:术后半年:A组在饮食限制、焦虑、腹泻等方面症状均差于B组和C组(P<0.05);B组返流症状重于A组和C组(P<0.05)。术后1年:A组的焦虑、腹泻症状均重于B组和C组(P<0.05);B组反流症状重于A组和C组(P<0.05)。结论:对于进展期SiewertⅡ型食管胃结合部腺癌,采用双通道吻合法的患者术后生活质量优于传统近端胃切除及全胃切除的患者,该术式值得临床推广。

Objective:To compare the quality of life of three different surgical procedures for advanced Siewert type Ⅱ adenocarcinomas of the esophagogastric junction,so as to provide theoretical basis for optimizing the surgical treatment of patients with advanced Siewert type Ⅱadenocarcinomas of the esophagogastric junction.Methods:105 patients with advanced Siewert Ⅱadenocarcinomas of the esophagogastric junction treated in the First Affiliated Hospital of Xi’an Jiaotong University from October 2015 to October 2017 were selected.According to the operation,the patients were divided into three groups:Total gastrectomy group(A group),traditional proximal gastrectomy group(B group) and double channel anastomosis group(C group).After quantification with the total quality of life scale(quality of life questionnaire core-30,QLQ-C30) and the esophagogastric junction cancer scale(quality of life questionnaire oesophagogastric-25,QLQ-OG25),the quality of life of the three groups were compared half a year and one year after operation.Results:QLQ-C30 showed in six months after operation,the scores of overall quality of life,physical function,fatigue and dyspnea in group C were better than those in group A and group B,while the scores of emotional function in group C were better than those in group A(P<0.05).The scores of role function,fatigue and diarrhea in group A were worse than those in group B and C(P<0.05).The symptoms of anorexia in group B were more severe than those in group A and group C(P<0.05).In one year after operation,the scores of overall quality of life,physical function and emotional function in group C were better than those in group A and group B(P<0.05),and the scores of role function in group C were better than those in group A(P<0.05).The symptoms of fatigue and diarrhea in group A were more severe than those in group B and C(P<0.05).The symptoms of anorexia in group B were more severe than those in group A and C(P<0.05).QLQ-OG25 showed in six months after operation,the scores of dietary restriction,anxiety and diarrhea in group A were worse than those in group B and C(P<0.05).The reflux symptoms in group B were more severe than those in group A and C(P<0.05).In one year after operation,the symptoms of anxiety and diarrhea in group A were more severe than those in group B and C(P<0.05).The reflux symptoms in group B were more severe than those in group A and C(P<0.05).Conclusion:For patients with advanced Siewert type Ⅱ adenocarcinoma of the esophagogastric junction,the postoperative quality of life underwent double-channel anastomosis is better than that of traditional proximal gastrectomy and total gastrectomy.