Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Qual Life Res. 2011 Mar;20(2):179-89. doi: 10.1007/s11136-010-9742-1. Epub 2010 Sep 21.
To compare the short-term health-related quality of life (HRQL) between the two different routes of gastric tube reconstruction after minimally invasive esophagectomy (MIE).
From January 2007 to June 2009, 97 patients who underwent three-incision subtotal MIE were enrolled in this retrospective study. Among them, 49 patients followed prevertebral route and 48 patients followed retrosternal route. The questionnaires (EORTC QLQ C-30 and OES-18) were applied to assess the HRQL of the patients before and 2, 4, 12, 24 weeks after operation.
All the patients underwent operation with no mortality. No statistical difference was found in age, gender, serum albumin level, the level of growth in the esophagus, pathological diagnosis, tumor stage, operation time, blood loss or ICU stay between the two groups. The perioperative complication rate was 35.4% in retrosternal group and 32.7% in prevertebral group (P = 0.774). However, the rate of cervical anastomotic leak in the retrosternal group was much higher (20.8 vs. 6.1%, P = 0.033). But the rate of cardiac or pulmonary complication in the retrosternal group seemed to be lower (10.4 vs. 22.4%, P = 0.110). Besides, the rate of anastomotic stricture was similar (6.3 vs. 10.2%, P = 0.735). And all HRQL measures did not show major differences between the two groups before operation. However, at the time of 2 weeks after operation, the dysphagia and eating problem questionnaires scores were higher in retrosternal group than in prevertebral group, which meant that the patients in retrosternal group suffered more severe problems; meanwhile, the scores of global quality scale in retrosternal group was also lower, which indicated that the patients had a worse global quality of life. Whereas, at the time of 12 and 24 weeks after operation, the dyspnoea and reflux symptom questionnaire scores were lower in retrosternal group than in prevertebral group, which revealed that there were less problems in the patients of retrosternal group; meanwhile, the score of global quality scale in retrosternal group was higher conversely, which suggested that the patients gain a better status in global quality of life.
Our results suggest that retrosternal route may be a good alternative choice for MIE in view of better HRQL after operation, although it has higher risk of anastomotic leak that might lead to worse HRQL in early period.
比较微创食管切除术（MIE）后两种不同胃管重建路径的短期健康相关生活质量（HRQL）。
本回顾性研究纳入了 2007 年 1 月至 2009 年 6 月期间接受三切口次全 MIE 的 97 例患者。其中，49 例患者采用经椎前途径，48 例患者采用经胸骨后途径。手术前后，应用 EORTC QLQ C-30 和 OES-18 问卷评估患者的 HRQL。
所有患者均顺利完成手术，无死亡病例。两组患者在年龄、性别、血清白蛋白水平、食管生长程度、病理诊断、肿瘤分期、手术时间、出血量或 ICU 停留时间等方面均无统计学差异。胸骨后组围手术期并发症发生率为 35.4%，椎前组为 32.7%（P = 0.774）。然而，胸骨后组的颈部吻合口漏发生率明显更高（20.8%比 6.1%，P = 0.033）。但是胸骨后组的心脏或肺部并发症发生率似乎较低（10.4%比 22.4%，P = 0.110）。此外，吻合口狭窄的发生率也相似（6.3%比 10.2%，P = 0.735）。并且两组患者手术前所有 HRQL 指标均无明显差异。然而，在术后 2 周时，胸骨后组的吞咽困难和饮食问题问卷评分高于椎前组，表明胸骨后组患者的问题更为严重；同时，胸骨后组的总体健康状况评分也较低，表明患者的整体生活质量较差。然而，在术后 12 和 24 周时，胸骨后组的呼吸困难和反流症状问卷评分低于椎前组，表明胸骨后组患者的问题较少；同时，胸骨后组的总体健康状况评分较高，表明患者的整体生活质量状况较好。
我们的结果表明，尽管胸骨后途径吻合口漏的风险较高，可能导致早期 HRQL 较差，但从术后 HRQL 来看，该途径可能是 MIE 的一种较好的选择。
