食管癌病人生活质量的纵向研究

A Longitudinal Study of Evluating the Quality of Patients with Esophageal Carcinoma

目的 评价手术治疗和姑息性治疗对食管癌患者短期和长期生活质量的影响。方法 采用欧洲肿瘤治疗研究组织的肿瘤病人生活质量评价体系定期对 88例连续收治的食管癌病人生活质量进行测量 ,直至患者死亡或术后 3年。在测量的各个时点计算术后生存两年以上 (n =16 )、术后两年内死亡 (n =34)和姑息治疗 (n =38)这三组病人的各评价指标得分中位数。结果 接受手术治疗的一、二组病人术前在功能和症状性指标中得分相近。在食管癌根治术后 6周 ,患者在多数功能性指标中得分较术前低 ,而在症状性指标中得分较高 ,这说明手术后病人生活质量下降 ;但手术 9个月后 ,第一组病人生活质量显著改善并接近术前水平 ,而第二组病人除了吞咽困难症状外 ,生活质量无明显改善。选择作姑息性治疗的病人在治疗前的生活质量比接受手术治疗的一、二组病人差 ,但经治疗后其生活质量与二组病人相近。结论 食管切除手术对患者生活质量有着潜在的负面影响。对于生存两年以上病人这种影响是暂时的 ;对于两年以内死亡的病人 ,这种影响是不可逆的。从生活质量的观点出发 ,对中晚期的食管癌病人选择姑息治疗是合理的。

objective To evaluate the impact on short and long term quality of life (QL) of esophagectomy and palliative treatment in patients with esophageal carcinoma. Methods 88 consecutive patients undergoing curative esophagectomy or purely palliative treatment had completed European Organization of Cancer Research and Treatment(EOCRT) QLQ-C30 measurement of QL before treatment at regular until death or 3 postoperative years. Median scores were obtained from patients surviving more than 2 years after surgery (the first group, n=16), from patients surviving less than 2 years after surgery (the second group, n=34) and from patients undergoing palliative treatment (the third group, n=38). Results Baseline functional and symptom QL scores were similar in the first and second group, and these were better than scores from the third group. Six weeks after esophagectomy , patients reported worse functional, symptom and global QL scores than before treatment. In the first group, QL scores returned to preoperative levels within 9 months, but apart from dysphagia improved after surgery, the second group never regained their former QL.QL scores of the third group were similar to those of the second group after treatment. Conclusions Esophagectomy has a negative impact on QL; this effect is transient for the first group but inreversible for the second group. In view of QL opinion, it is reasonable for patients of late stage to be treated through palliative ways.