胃癌不同重建方式对生存质量的影响

Effect of Different Reconstruction Modes on Quality of Life in Gastric Carcinoma

目的探索胃癌不同消化道重建对术后生存质量的影响,为评价胃癌术后不同消化道重建方式的特点以及生存质量的客观指标提供科学依据。方法纳入资阳市第一人民医院及绵阳四0四医院2012年1月至2013年12月经胃镜确诊为进展期胃癌患者122例,根据不同病变部位与不同重建方式分成A、B、C三组,A组28例,为胃下部癌行毕Ⅰ式消化道重建; B组58例,以贲门和胃小弯等为主的胃上部癌,其中全胃切除35例,胃部分切除23例,均施行空肠代胃调节型双通道消化道重建; C组36例,以胃中上部癌为主,全胃切除25例,胃部分切除11例,该组为不通过十二指肠通的重建术式。采用欧洲癌症研究与治疗组织(European Organization for Research and Treatment of Cancer,EORTC) QLQ-C30、QLQ-STO22生活量表评分,比较三种术式间生存质量。结果三组间在整体生存质量、食欲丧失、吞咽困难、反流、饮食受限、味觉方面比较,P<0. 05,差异有统计学意义,进行两两比较后:A、B组之间均P>0. 05; B、C组之间P<0. 05; A、C间食欲丧失、反流、饮食受限、味觉,P<0. 05。结论调节型双通道消化道重建,其生存质量优于毕Ⅰ式及不经十二指肠方法,可以大大减少患者的不良反应,早期提高患者的生存质量。

Objective To explore the effect of different reconstruction of digestive tract on postoperative quality of life of gastric cancer,and to provide scientific basis for evaluating the characteristics of different reconstructions of digestive tract andobjective index of quality of life after operation of gastric cancer. Methods From January 2012 to December 2013,122 patients with advanced gastric cancer diagnosed by gastroscopy in the First People’s Hospital of Ziyang and Mianyang 404 Hospital were selected and divided into A,B,C three groups according to different lesion sites and different reconstruction methods: Group A( n =28) with carcinoma of the lower part of the stomach underwent Bi-Ⅰreconstruction of digestive tract;In group B,58 patients were upper gastric carcinoma,mainly cardia and small curvature of stomach,including 35 cases of total gastrectomy and 23 cases of partial gastrectomy,and all patients underwent the jejunal and stomach-regulating type double-channel digestive tract reconstruction;In group C,36 cases were mainly middle and upper gastric carcinoma,25 cases with total gastrectomy and 11 cases with partial gastrectomy,and this group was a reconstructive formula that did not pass through the duodenal passage. The quality of life of the three operations was compared by using the European Organization for Research and Treatment of Cancer( EORTC) QLQ-C30,QLQSTO22 Life scale. Results There were significant differences in overall quality of life,loss of appetite,dysphagia,reflux,limited diet and taste between the three groups( P<0. 05). After pairwise comparison,no significant difference between group A and B( P>0. 05);but there was significant difference between group B and group C( P<0. 05);there was significant difference between group A and group C in loss of appetite,regurgitation,restricted diet and taste sensation( P<0. 05). Conclusion The quality of life of the regulated double-channel digestive tract reconstruction is better than that of Bi-Ⅰand non-duodenal method,which can greatly reduce the adverse reactions of patients and improve the quality of life of the patients at the early stage.