胸腹腔镜联合食管癌切除经胸骨后胃-食管颈部器械吻合术后患者生活质量的评价  

Quality of life in patients with esophageal carcinoma undergoing thoracoscopic and laparoscopic esophagectomy and circular stapled cervical esophagogastric anastomosis via retrosternal route

作　　者：王禹冰[1] 蔡瑞君[1] 韩亚娟[2] 王武军[1] 杨锡耀[1] 刘素娥[1] 

机构地区：[1]南方医科大学南方医院胸心外科,广州510515 [2]南方医科大学南方医院内分泌代谢科,广州510515

出　　处：《中华胃肠外科杂志》2011年第6期428-431,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的评价胸腔镜和腹腔镜联合行食管癌切除，经胸骨后胃一食管颈部圆形吻合器吻合术与颈胸腹三切口食管癌切除术对患者术后生活质量的影响。方法南方医科大学南方医院胸心外科于2009年1月至2010年10月手术治疗63例胸部中上段食管癌患者，其中行胸腔镜和腹腔镜联合食管癌切除术33例（A组），颈胸腹三切口食管癌切除术30例（B组）。采用欧洲癌症研究与治疗组织（EORTC）开发的生活质量核心量表QLQ-C30和食管癌补充量表QLQ—OES18评价患者术后的生活质量。结果两组患者一般资料的比较除吻合方式不同外，差异均无统计学意义（P〉0．05）．A组患者术后分别发生颈部吻合口瘘1例（3．0％，1／33）、颈部切口感染1例（3．0％，1／33）和吻合口狭窄1例（3．0％，1／33）：B组发生吻合口瘘8例（26．7％，8／30），吻合口狭窄2例（6．7％．2／30）．颈部切口感染1例（3．3％，1／30），肺部感染6例（20．0％，6／30）；均经保守治疗后好转。A组患者术后在吞咽闲难、进食、疼痛、梗阻、呼吸困难、食欲丧失、疲倦、经济困难、躯体功能、角色功能、情绪功能、认知功能、社会功能及总体健康状况维度方面的评分均优于B组，差异有统计学意义（P〈0．05）：其余维度差异无统计学意义。结论胸腔镜和腹腔镜联合食管癌切除术患者颈部器械吻合后并发症发生率低．生活质量明显优于颈胸腹三切口手术的患者。Objective To evaluate the quality of life （QOL） in patients with esophageal carcinoma after thoraeoseopic and laparoscopic esophagectomy and circular stapled cervical esophagogastric anastomosis via retrosternal route or three-incision open surgery. Methods A total of 63 patients with middle-upper esophageal carcinoma who underwent radical surgical resection from January 2009 to October 2010 were enrolled in this study. Thirty-three patients underwent combined laparoseopic and thoracoscopic surgery and 30 three-incision open surgery. The EORTC questionnaire QLQ-C30 and QLQ-OES18 were used to evaluate the QOL. Results There were no significant differences in the clinical data between the two groups except for anastomosis method（P〉0.05）. In the endoscopy group, there was one patient developed anastomotic leakage（3.0%, 1/33）, 1 postoperative wound infection in the neck （3.0%, 1/33）, and 1 anastomotic stricture（3.0%, 1/33）. In the open group, 8 patients had anastomotic leakage （26.7%, 8/30）, 2 had anastomotic stricture （6.7%, 2/30）, 1 had wound infection in the neck （3.3%, 1/30）, and 6 had pulmonary infection （20.0% ,6/30）. All the complications were managed by conservative treatment. The two groups differed in dysphagia, food intake, pain, obstruction, dyspnea, anorexia, fatigue, financial condition, physical function, role function, emotional function, cognitive function, social function and global health level and were more favorable in the endoscopy group （P〈0.05）, while there were no significant differences in the other dimensions. Conclusions The postoperative complication rate is low after thoracoscopic and laparoscopic esophagectomy. Stapled anastomosis is associated with lower rate of anastomotic leak. QOL is better in patients following thoracoscopic and laparoscopic esophagectomy as compared to those following three-incision open surgery.

关 键 词：食管肿瘤 胸腔镜:腹腔镜 食管肿瘤切除术 生活质量 

分 类 号：R735.1[医药卫生—肿瘤]