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目的对比食管胃交界部癌采用不同手术方式治疗的效果,以及术后患者的生活质量,探讨合理的手术方法。方法 2007年7月至2011年10月徐州市第一人民医院收治的食管胃交界部癌患者148例,男111例,女37例,平均年龄64(47～77)岁。根据术前评估和肿瘤外侵情况不同对148例食管胃交界部癌患者分别采用不同的手术方式,并分为3组。A组:81例,行胃近端大部切除、食管胃弓下吻合术;B组:20例,行全胃切除、食管空肠吻合术;C组:47例,行胃近端大部切除、食管残胃间空肠间置术。术后观察3组患者的手术死亡率、术后并发症发生率;术后1年观察复发转移率和病死率,并且用EORTC QLQ问卷表对随访的患者进行问卷调查,进行术后生活质量评价。结果 3组患者术后并发症发生率(P=0.762)和手术死亡率(P=0.650)差异无统计学意义,术后1年3组复发转移率比较差异无统计学意义(P=0.983);术后1年3组患者的生存率均为100%。术后1年A组、C组患者躯体功能(P=0.037,0.000)和总体健康状况评分(P=0.035,0.006)明显高于B组,而A组与C组比较差异无统计学意义(P>0.05)。B组患者情绪功能评分明显低于C组(P=0.015)。A组、C组患者术后疲劳(P=0.040,0.006)、食欲丧失(P=0.045,0.025)、恶心呕吐症状评分(P=0.033,0.048)明显低于B组;A组疼痛症状评分低于C组(P=0.009),失眠症状评分高于C组(P=0.028);反流症状评分明显高于B组、C组(P=0.025,0.021)。结论食管胃交界部癌行全胃切除患者术后的生活质量较差,而行胃近端大部切除、食管残胃间空肠间置术能明显改善患者术后的生活质量,术后患者生活质量评价可能有助于手术方式的选择。
Objective To compare the effect of esophageal and gastric cancer treated with different surgical methods and the quality of life of postoperative patients and to explore reasonable surgical methods. Methods From July 2007 to October 2011, 148 cases of esophagogastric junction cancer were treated in Xuzhou First People ’s Hospital, including 111 males and 37 females, with an average age of 64 (47-77) years. According to preoperative evaluation and tumor invasion, 148 cases of esophagogastric junction cancer patients were treated with different methods and divided into 3 groups. In group A, 81 cases underwent partial resection of the proximal stomach and anastomosis under the esophageal and gastric arch. In group B, 20 cases underwent total gastrectomy and esophageal jejunostomy. In group C, 47 cases underwent resection of the proximal part of the stomach Esophageal gastric jejunal interposition. The postoperative morbidity and mortality of the three groups were observed. The recurrence, metastasis rate and mortality of the patients were observed one year after operation. The patients were followed up by EORTC QLQ questionnaire to evaluate the postoperative quality of life . Results There was no significant difference in postoperative complication rate (P = 0.762) and operative mortality (P = 0.650) between the three groups. There was no significant difference in the recurrence and metastasis rates between the three groups (P = 0.983) The survival rates of three groups were 100% after 1 year. Body function (P = 0.037, 0.000) and overall health status score (P = 0.035, 0.006) in group A and group C at 1 year after operation were significantly higher than those in group B, but there was no significant difference between group A and group C P> 0.05). The scores of emotional function in group B were significantly lower than those in group C (P = 0.015). The pain scores in group A and group C were significantly lower than those in group B after operation (P = 0.040,0.006), loss of appetite (P = 0.045,0.025), and nausea and vomiting (P = 0.033,0.048) In group C (P = 0.009), insomnia symptom scores were higher than those in group C (P = 0.028). The scores of reflux symptoms were significantly higher than those in group B and C (P = 0.025,0.021). Conclusions The quality of life after total gastrectomy in patients with esophagogastric junction cancer is poor. However, the resection of the proximal part of the stomach with jejunum esophagogastrostomy can significantly improve the postoperative quality of life, postoperative patient life Quality evaluation may help the choice of surgical approach.