远端胃癌根治术Billroth-Ⅰ式与Billroth-Ⅱ式消化道重建术后中长期生活质量比较:基于病例登记数据库的队列研究  

Comparison of postoperative mid-term and long-term quality of life between Billroth-I gastroduodenostomy and Billroth-II gastrojejunostomy after radical distal gastrectomy in patients with gastric cancer: a cohort study based on a case registry database

作　　者：汤宽妮 陈小龙[1] 张维汉[1] 杨昆[1] 刘凯[1] 江雯[2] 陈心足 胡建昆[1] Tang Kuanni;Chen Xiaolong;Zhang Weihan;Yang Kun;Liu Kai;Jiang Wen;Chen Xinzu;Hu Jiankun(Department of Gastrointestinal Surgery and Gastric Cancer Laboratory,West China Hospital,Sichuan University,Chengdu 610041,China;University of Electronic Science and Technology of China Hospital,Chengdu 611731,China;The Second People's hospital of Yibin,Yibin 644000,China)

机构地区：[1]四川大学华西医院胃肠外科中心&胃癌研究室,成都610041 [2]电子科技大学医院外科,成都611731 [3]宜宾市第二人民医院四川大学华西医院宜宾医院胃肠疝外科,宜宾644000

出　　处：《中华胃肠外科杂志》2022年第5期401-411,共11页Chinese Journal of Gastrointestinal Surgery

基　　金：四川大学华西医院学科卓越发展1·3·5工程项目(ZYJC21006)。

摘　　要：目的分析比较远端胃癌根治术Billroth-Ⅰ式(B-Ⅰ)与Billroth-Ⅱ式(B-Ⅱ)消化道重建患者术后的中长期生活质量。方法采用回顾性队列研究方法,收集四川大学华西医院胃肠外科中心胃癌外科病例登记数据库中2016年1月至2020年12月期间,行远端胃癌根治术的859例患者临床病理和随访资料。纳入标准:(1)术前经胃镜和活检明确胃癌诊断;(2)按照日本胃癌学会胃癌治疗指南择期实施根治性远端胃大部切除;(3)术后病理分期为Ⅰ~Ⅲ期的患者,TNM分期参照美国癌症联合会第8版标准;(4)术中联合脏器切除术只涉及胆囊或阑尾;(5)消化道重建方式为B-Ⅰ或B-Ⅱ;(6)临床病理资料完整;(7)截止随访区间2021年12月15日至2022年1月15日内存活。排除标准:(1)随访依从性不佳;(2)问卷评价信息不全;(3)带瘤存活者;(4)合并其他系统恶性肿瘤;(5)合并精神系统疾病、神经系统疾病等严重影响问卷调查客观性或患者认知受干扰的情况。由固定的研究者于2021年12月至2022年1月开展电话随访,以欧洲肿瘤治疗与研究组织研发的标准化问卷(EORTC)QLQ-C30评分(症状领域、功能领域和总体健康状况)和EORTC QLQ-STO22评分(包括吞咽困难、疼痛、反流、进食受限、焦虑5个症状;口干、味觉、躯体形象、脱发4个单项项目)进行术后生活质量评价。全组859例患者,女性271例,男性588例;中位年龄57.0(49.5,66.0)岁。按术后随访年限,将纳入病例分为术后随访1年组(202例)、术后随访2年组(236例)、术后随访3年组(148例)、术后随访4年组(129例)和术后随访5年组(144例);每组再根据患者消化道重建方式为B-Ⅰ重建组和B-Ⅱ重建组,除术后随访4年组中B-Ⅰ重建组与B-Ⅱ重建组的肿瘤T分期、术后随访5年组中B-Ⅰ重建组与B-Ⅱ重建组的患者年龄、肿瘤T分期和肿瘤TNM分期比较,差异具有统计学意义(均P<0.05)外,其余术后随访各年份组中的B-Ⅰ重建组与Objective The pattern of digestive tract reconstruction in radical gastrectomy for gastric cancer is still inconclusive.This study aims to compare mid-term and long-term quality of life after radical gastrectomy for distal gastric cancer between Billroth-I(B-I)and Billroth-II(B-II)reconstruction.Methods A retrospective cohort study was conducted.Clinicopathological and follow-up data of 859 gastric cancer patients were colected cellected from the surgical case registry database of Gastrointestinal Surgery Center of Sichuan University West China Hospital,who underwent radical distal gastric cancer resection between January 2016 and December 2020.Inclusion criteria:(1)gastric cancer confirmed by preoperative gastroscopy and biopsy;(2)elective radical distal major gastrectomy performed according to the Japanese Society for Gastric Cancer treatment guidelines for gastric cancer;(3)TNM staging referenced to the American Cancer Society 8th edition criteria and exclusion of patients with stage IV by postoperative pathology;(4)combined organ resection only involving the gallbladder or appendix;(5)gastrointestinal tract reconstruction modality of B-I or B-II;(6)complete clinicopathological data;(7)survivor during the last follow-up period from December 15,2021 to January 15,2022.Exclusion criteria:(1)poor compliance to follow-up;(2)incomplete information on questionnaire evaluation;(3)survivors with tumors;(4)concurrent malignancies in other systems;(5)concurrent psychiatric and neurological disorders that seriously affected the objectivity of the questionnaire or interfered with patient's cognition.Telephone follow-up was conducted by a single investigator from December 2021 to January 2022,and the standardized questionnaire EORTC QLQ-C30 scale(symptom domains,functional domains and general health status)and EORTC QLQ-STO22 scale(5 symptoms of dysphagia,pain,reflux,restricted eating,anxiety;4 single items of dry mouth,taste,body image,hair loss)were applied to evaluate postoperative quality of life.In 859 patients,271 we

关 键 词：胃肿瘤 远端胃大部切除 消化道重建 Billroth-Ⅰ式 消化道重建 Billroth-Ⅱ式 生活质量 

分 类 号：R735.2[医药卫生—肿瘤]