Saito Shin, Nakamura Misuzu, Hosoya Yoshinori, Kitayama Joji, Lefor Alan Kawarai, Sata Naohiro
Department of Surgery, Jichi Medical University, Tochigi, Japan.
Department of Nursing, Jichi Medical University, Tochigi, Japan.
Ann Med Surg (Lond). 2017 Aug 24;22:34-38. doi: 10.1016/j.amsu.2017.08.016. eCollection 2017 Oct.
Patients with esophageal cancer and a history of gastrectomy or concurrent gastric cancer undergo not only esophagectomy but also total gastrectomy. The goal of this study is to evaluate the postoperative quality of life (QOL) and dysfunction of these patients using two postoperative questionnaires.
From 1999 to 2015, 41 patients underwent concurrent esophagectomy and total gastrectomy. A jejunal pedicle with the subcutaneous supercharge technique was used for reconstruction. Patients were divided into two groups, including those undergoing concurrent esophagostomy and gastrectomy (Group 1), and those undergoing esophagectomy alone (Group 2, history of previous gastrectomy). Patients were analyzed by time interval, including patients within three years of surgery (Group A) and those more than three years after surgery (Group B).
Eighteen patients completed the questionnaires. The mean DAUGS20 score was 26.4 ± 13.2. The DAUGS20 scores of groups 1 (N = 7) and 2 (N = 11) were 25.4 ± 12.5 and 27 ± 15.4 (p = 0.58), respectively. Global health status scored by the EORTC QLQC-30 were 71.4 ± 18.5 in group 1 and 67.4 ± 22.8 in group 2 (p = 0.85). DAUGS20 scores of group A (N = 10) and B (N = 8) were 28.1 ± 12.4 and 23.3 ± 14.4 (p = 0.35). No significant differences were found between groups A and B regarding the QLQ-C30 scores.
DAUGS20 and QLQ-C30 scores showed no significant differences between groups 1 and 2 or groups A and B. These results suggest that postoperative QOL and dysfunction may be influenced more by current status than by surgical history and postoperative interval. Previous reports describe a DAUGS 20 score after gastrectomy of 27.8 and after esophagectomy of 36.1. The DAUGS20 score of these 18 patients is lower than DAUGS20 scores for patients undergoing either operation alone. Reconstruction using a subcutaneously placed jejunal segment seems to be reasonable.
患有食管癌且有胃切除术史或同时患有胃癌的患者不仅要接受食管切除术，还要接受全胃切除术。本研究的目的是使用两份术后问卷评估这些患者的术后生活质量（QOL）和功能障碍。
1999年至2015年，41例患者接受了同期食管切除术和全胃切除术。采用带皮下增压技术的空肠蒂进行重建。患者分为两组，包括同期接受食管造口术和胃切除术的患者（第1组），以及仅接受食管切除术的患者（第2组，既往有胃切除术史）。按时间间隔对患者进行分析，包括术后三年内的患者（A组）和术后三年以上的患者（B组）。
18例患者完成了问卷。DAUGS20平均得分为26.4±13.2。第1组（N = 7）和第2组（N = 11）的DAUGS20得分分别为25.4±12.5和27±15.4（p = 0.58）。欧洲癌症研究与治疗组织生活质量核心问卷（EORTC QLQC-30）评估的总体健康状况在第1组为71.4±18.5，在第2组为67.4±22.8（p = 0.85）。A组（N = 10）和B组（N = 8）的DAUGS20得分分别为28.1±12.4和23.3±14.4（p = 0.35）。A组和B组在QLQ-C30得分方面未发现显著差异。
DAUGS20和QLQ-C30得分在第1组和第2组之间或A组和B组之间均无显著差异。这些结果表明，术后生活质量和功能障碍可能更多地受当前状况影响，而非手术史和术后间隔。既往报告描述胃切除术后DAUGS 20得分为27.8，食管切除术后为36.1。这18例患者的DAUGS20得分低于单独接受任何一种手术的患者的DAUGS20得分。使用皮下放置的空肠段进行重建似乎是合理的。
