腹腔镜胃癌根治术中保留迷走神经对早期远端胃癌患者生活质量的影响

Influence of laparoscopic vagus nerve-preserving distal gastrectomy on the postoperative quality of life in patients with early-stage distal gastric cancer

目的:探讨腹腔镜胃癌根治术中保留迷走神经(VPG)对早期远端胃癌患者术后生活质量的影响。方法:早期远端胃癌患者142例随机分为VPG组(n=73)和常规远端胃癌根治术(CG)组(n=69),分别采用腹腔镜VPG和CG。比较两组围手术期相关指标及术后3年内生存、复发情况,术前及术后3个月、12个月,采用欧洲癌症治疗研究组织(EORTC)癌症患者生活质量量表核心量表30项(QLQ-C30)中文版和胃癌特异性评价量表(EORTC QLQ-STO22)评价患者的生活质量。结果:VPG组术后肛门排气时间显著短于CG组(P<0.05),但两组淋巴结清扫数、手术时间、术中出血量比较,差异无统计学意义(P>0.05)。术后3个月,VPG组QLQ-C30中疲劳、恶心呕吐、食欲下降、便秘、腹泻评分及QLQ-STO22量表中进食受限、反流、口干、体型评分显著低于CG组(P<0.05);术后12个月,VPG组QLQ-C30中食欲下降、腹泻评分及QLQSTO22中体型评分显著低于CG组(P<0.05)。VPG组术后1、3年生存率及累计复发率分别为100%、95.89%、8.22%,与CG组的100.00%、97.10%、5.80%比较,差异均无统计学意义(P>0.05)。结论:腹腔镜VPG治疗早期远端胃癌安全有效,可减少术后1年腹泻、食欲下降、体型改变,改善术后生活质量。

Objective:To investigate the influence of laparoscopic vagus nerve-preserving distal gastrectomy(VPG)on the postoperative quality of life(QOL)in patients with early stage distal gastric cancer.Methods:142 patients with early-stage distal gastric cancer were divided into VPG group(n=73)and conventional distal gastrectomy(CG)group(n=69).All the patients of the two groups underwent laparoscopic VPG and CG respectively.The perioperative indicators,survival and recurrence within 3 years after surgery were compared between the two groups.The Quality of Life Questionnare-Core 30(QLQ-C30)and Quality of Life QuestionnareStomach Cancer 22(QLQ-STO22)were used to evaluate the QOL.Results:The anus exhaust time was significantly shorter in the VPG group than that in the CG group(P<0.05),but there was no significant difference in the number of lymph node dissection,operation time and intraoperative blood loss between the two groups(P>0.05).3 months after surgery,fatigue,nausea and vomiting,appetite loss,constipation,diarrhea scores of QLQ-C30 and eating restriction,reflux,thirst,body image scores of QLQ-STO22 scale in the VPG group were significantly lower than those in the CG group(P<0.05);12 months after surgery,appetite loss,diarrhea and body image scores in the VPG group were significantly lower than those in the CG group(P<0.05).The 1-year and 3-year survival rates,cumulative recurrence rate were 100%,95.89%and 8.22%in the VPG group respectively,compared with 100.00%,97.10%and 5.80%in the CG group,the difference was not statistically significant(P>0.05).Conclusion:Laparoscopic VPG is safe and effective in the treatment of early-stage distal gastric cancer,which can reduce the diarrhea,appetite loss,body shape change and improve the postoperative quality of life at 1 year after surgery.