[经胸腔镜和腹腔镜行食管癌切除术并经胸骨后途径行圆形吻合器颈部食管胃吻合术患者的生活质量]

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

作者信息

Wang Yu-bing, Cai Rui-jun, Han Ya-juan, Wang Wu-jun, Yang Xi-yao, Liu Su-e

机构信息

Department of Cardio-Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.

出版信息

Zhonghua Wei Chang Wai Ke Za Zhi. 2011 Jun;14(6):428-31.

PMID:21713702

Abstract

OBJECTIVE

To evaluate the quality of life (QOL) in patients with esophageal carcinoma after thoracoscopic 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 laparoscopic 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.

摘要

目的

评估经胸腔镜和腹腔镜食管切除术及经胸骨后途径圆形吻合器颈部食管胃吻合术或三切口开放手术治疗食管癌患者的生活质量（QOL）。

方法

本研究纳入了2009年1月至2010年10月期间接受根治性手术切除的63例中上段食管癌患者。33例患者接受了腹腔镜和胸腔镜联合手术，30例接受了三切口开放手术。采用欧洲癌症研究与治疗组织（EORTC）问卷QLQ-C30和QLQ-OES18评估生活质量。

结果

除吻合方法外，两组临床资料差异无统计学意义（P>0.05）。在内镜组，1例患者发生吻合口漏（3.0%，即1/33），1例颈部术后伤口感染（3.0%，即1/33），1例吻合口狭窄（3.0%，即1/33）。在开放组，8例患者发生吻合口漏（26.7%，即8/30），2例发生吻合口狭窄（6.7%，即2/30），1例颈部伤口感染（3.3%，即1/30），6例发生肺部感染（20.0%，即6/30）。所有并发症均采用保守治疗。两组在吞咽困难、食物摄入、疼痛、梗阻、呼吸困难、厌食、疲劳、经济状况、身体功能、角色功能、情感功能、认知功能、社会功能和总体健康水平方面存在差异，内镜组更具优势（P<0.05），而在其他维度上差异无统计学意义。