食管癌切除术患者运动能力、肌肉力量和生活质量的相关性分析

Changes in Exercise Capacity,Muscle Strength,and Health-related Quality of Life in Esophageal Cancer Patients Undergoing Esophagectomy

目的:探讨食管癌患者术前功能锻炼能力、肌力、焦虑、抑郁和健康相关生活质量(QOL)的特点,并评估食管癌根治术对这些参数的影响。方法:我们对2019年1-12月36例新诊断的可切除食管癌患者进行回顾性分析,这些患者接受了食管切除术并进行了术后康复治疗。术前、术后2周分别进行6 min步行距离(6MWD)、膝伸肌肌力、握力、医院焦虑抑郁量表(HADS)和慢性阻塞性肺疾病(COPD)评定量表(CAT)测试。术前进行肺功能测试,并对MOS 36项目健康问卷(SF-36)的组成部分进行一般健康评定。结果:患者平均年龄66.1±9.2岁。患者以男性为主(75.0%),有较高的吸烟史(80.6%),鳞状细胞癌(94.4%)。COPD 15例。临床分期:0-I期11例,II期6例,III期15例,IV期4例。29例行开腹手术。SF-36评分的组成部分与CAT和HADS评分显著相关,COPD患者的身体状况明显差于非COPD患者(P<0.05)。比较术前和术后的数值,发现术后6MWD、握力、等长膝伸肌肌力显著降低,CAT评分显著升高(P<0.05),HADS评分无明显升高(P>0.05)。在多元回归分析中,术后6MWD的下降与术前SF-36的生理成分总结显著相关。结论:从微创手术和围手术期处理的角度来看,有必要进一步改进围手术期的康复。在手术后两周,食管切除术对健康相关的QOL和身体健康有害,需建立围手术期康复策略,以改善术后结果。

Objective:To characterize the preoperative functional exercise capacity,muscle strength,anxiety,depression,and health-related quality of life(QOL)in patients with esophageal cancer,and to evaluate the impact of radical esophagectomy on these parameters.Methods:We performed a retrospective review of 36 consecutive patients with newly diagnosed resectable esophageal cancer who underwent esophagectomy followed by postoperative rehabilitation from January to December 2019.Patients were tested for 6-min walk distance(6MWD),knee-extensor muscle strength,hand grip strength,the Hospital Anxiety and Depression Scale(HADS),and the chronic obstructive pulmonary disease(COPD)assessment test(CAT)before and two weeks after the surgery.Before surgery,the pulmonary function test,and components of the MOS 36-item Short-Form Health Survey(SF-36)Questionnaire for general health were assessed.Results:The mean age was 66.1±9.2 years.The patients were predominantly male(75.0%),had high rates of smoking history(80.6%),and squamous cell carcinoma(94.4%).15 patients had COPD.The clinical stage was 0-I in 11 patients,II in 6 patients,III in 15patients,and IV in 4 patients.29 patients(91.2%)underwent open surgery.At the baseline,components of the SF-36 scores significantly correlated with CAT and HADS scores,and the physical status was poorer in patients with COPD than those without(P<0.05).Comparisons between the preoperative and postoperative values revealed decreases in 6MWD,hand grip strength,isometric knee extensor muscle strength(P<0.05),and a increase in CAT scores but not in HADS scores after surgery(P>0.05).In multiple regression analysis,decreases in 6MWD after the surgery correlated with the preoperative physical component summary of SF-36(P<0.05).Conclusion:From the perspective of minimally invasive surgery and perioperative management,it is necessary to further improve perioperative rehabilitation.Two weeks after surgery,esophagectomy is harmful to health-related QOL and physical health.Perioperative rehabilitation strategies need to be established to improve postoperative outcomes.