手辅助电视胸腔镜食管癌切除术后患者近期生命质量的研究  

A prospective longitudinal study examining the impact on short term quality of life of hand video-assisted thoracoscopic surgical esophagectomy in patients with esophageal cancer

作　　者：关庆民[1] 杜贾军[1] 孟龙[1] 陈景寒[1] 

机构地区：[1]山东大学山东省立医院胸外科

出　　处：《中华外科杂志》2007年第10期688-691,共4页Chinese Journal of Surgery

摘　　要：目的评价手辅助电视胸腔镜食管癌切除术(HVATS)和 Ivor-Lewis 手术对食管癌患者术后近期生命质量的影响。方法将39例胸中段食管癌患者随机分为 HVATS 组(n=21)及 Ivor-Lewis 组(n=18),采用欧洲癌症研究与治疗组织的食管癌患者生命质量评价体系,定期测定至术后6个月时止,计算各时点各维度指标平均值。结果两组患者术前各维度指标得分相近,术后6个月内功能性指标得分均较术前低(P=0.011),症状性指标得分均较术前高(P=0.035)。HVATS 组功能性指标得分较 Ivor-Lewis 组下降幅度小,术后3～6个月时逐渐接近正常,Ivor-Lewis 组术后3～6个月时也得到改善,但较 HVATS 组差。术后两组患者在食管癌特有症状如吞咽困难、胃食管反流等方面差异无统计学意义。结论食管癌患者生命质量在术后近期明显下降;与 Ivor-Lewis 手术相比,HVATS 手术可减小患者术后近期生命质量下降幅度;从提高生命质量角度出发,对部分早中期胸中段食管癌采用 HVATS 术式是一个较好选择。Objective To evaluate the impact of hand video-assisted thoracoscopic surgery （HVATS） and ivor-lewis surgery on short term quality of life （QL） of patients with esophageal cancer. Methods Thirty-nine consecutive patients with esophageal cancer were classified into HVATS group （n = 21） and Ivor-lewis group （ n = 18 ） randomly, all patients completed the Chinese versions of the European Organization for Research and Treatment of Cancer （EORTC） Quality of Life Questionnaire （QLQ） -C30 and QLQ-OES18 before treatment and at regular intervals until 6 months after operation. MEAN scores were calculated for every patient. Results Baseline functional and symptom QL MEAN scores were similar in both groups. All patients reported worse functional, symptom and global QL scores （QOL） within 6 months after operation than before. HVATS group gained higher functional, global QL scores and lower symptom scores than Ivor-lewis group, moreover,patients＇ QL scores of HVATS group returned to preoperative levels more quickly than those patients in Ivor-lewis group. Significant differences were found in global health （QOL）, physical functioning, fatigue and pain scales between groups. In both groups, QLQ-OES18 dysphagia scales were improved after surgery, but no signifcent differences were found at scales respect to esophageal cancer. Conclusions HVATS esophagectomy is a safe procedure which has a low disturbance to patients＇ short term Quality of Life compared with Ivor-Lewis esophagectomy. It might seem reasonable to choose HVATS esophagectomy for patients with early stage esophageal cancer.

关 键 词：食管肿瘤 食管切除术 胸腔镜 生命质量 

分 类 号：R735.1[医药卫生—肿瘤]