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Jiang’s吻合对食管癌切除患者术后生活质量的影响

Study on Health-related Quality of Life in Patients with Jiang's Gastroesophageal Anastomosis after Oncologic Esophagectomy

  • 摘要:
      目的  比较管状胃代食管的食管癌切除术Jiang’s胃-食管吻合与传统端侧吻合对患者术后生活质量的影响。
      方法  选取我科2012年10月至2016年8月行手术治疗的食管癌419例,根据食管-胃吻合方式不同分为2组:Jiang’s吻合组223例,传统端侧吻合组196例。采用EORTC-QLQ-C30与QLQ-OES18量表评估术后1、3、6、12、24月的生活质量。
      结果  EORTC-QLQ-C30与QLQ-OES1量表共25个维度和项目。患者生活质量在术后第1月明显下降,第6月时恢复较快;术后第1、2年生活质量基本波动在较小范围内。术后第1月,Jiang’s吻合组反流、咳嗽两个维度的得分优于端侧吻合组(P=0.023, P=0.010);第3月Jiang’s吻合组反流、咳嗽两个维度的得分优于端侧吻合组(P=0.004, P=0.013);术后6月时,Jiang’s吻合组情绪功能、反流、咳嗽三个维度的得分优于端侧吻合组(P=0.013, P=0.014, P=0.043)。术后1年Jiang’s吻合组恶心与呕吐、情绪功能、反流三个维度的得分优于端侧吻合组(P=0.023,P=0.004, P=0.021)。术后2年Jiang’s吻合组反流维度的得分仍优于端侧吻合组(P=0.020)。其他维度和项目差异在随访期间没有统计学意义。
      结论  与传统端侧吻合相比较,Jiang’s吻合安全可行,有效减少术后主要并发症,提高患者术后生活质量,值得进一步推广。

     

    Abstract:
      Objective  To compare the difference of health-related quality of life after oncologic esophagectomy between the patients using Jiang's gastroesophageal anastomosis and traditional end-to-end gastroesophageal anastomosis.
      Methods  A total of 419 patients (223 in Jiang's anastomosis group, and 196 in end-to-end anastomosis group) underwent minimal invasive esophagectomy with cervical anastomosis from October 2012 to August 2016. All patients received radical esophageal cancer resection and cervical anastomosis. EORTC-QLQ-C30 and QLQ-OES18 were used to assess the health-related quality of life at the 1st, 3rd, 6th, 12th, 24th month after esophagectomy.
      Results  There were 25 dimensions and items in EORTC-QLQ-C30 and QLQ-OES18. The postoperative quality of life decreased obviously at the 1st month and then recovered obviously at the 6th month after the surgery, and it ranged small at the 12th and 24th month. Compared with end-to-end anastomosis group, Jiang's anastomosis group had less reflux and less cough at the 1st month (P=0.023, P=0.010) and the 3rd month (P=0.004, P=0.013), then had better emotional function, less reflux and less cough at the 6th month (P=0.013, P=0.014, P=0.043), better emotional function, less nausea, and less reflux at the 12th month(P=0.004, P=0.023, P=0.021), as well as less reflux at the 24th month (P=0.020). There was no significant difference in other dimensions and items between the two groups during the follow-up period.
      Conclusion  Jiang's anastomosis is safe and feasible, and could improve the postoperative quality of life of the patients with esophagectomy. It is worth to further application in clinical practice.

     

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