Nakahara Y, Yamasaki M, Miyazaki Y, Tanaka K, Makino T, Takahashi T, Kurokawa Y, Nakajima K, Takiguchi S, Mori M, Doki Y
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita.
Department of Surgery, Kinki Central Hospital, Itami, Japan.
Dis Esophagus. 2018 Jul 1;31(7). doi: 10.1093/dote/doy001.
Reflux following an esophagectomy with gastric conduit reconstruction in the posterior mediastinum is a clinically significant problem. In this study, we investigated the frequency and impact of reflux on the quality of life (QOL) among 158 patients who underwent an esophagectomy for esophageal cancer using an original questionnaire and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Version 3.0 (EORTC QLQ-C30). Reflux frequency was assessed using the original questionnaire. The number of patients who complained of reflux every day, two or three times a week, once a week, or less than once a week was 16 (10.1%), 21 (13.3%), 26 (16.5%), and 60 (38.0%), respectively. Out of 35 patients (22.2%) reported no reflux symptoms. Patients were divided into two groups: those with reflux ≥ once/week (63 patients) and those with low frequency of symptoms (95 patients). Time elapsed following surgery was the only factor to influence reflux frequency. Reflux frequency decreased within two years of surgery; however, the frequency plateaued after more than two years. QOL was assessed using the EORTC QLQ-C30. The ≥ once/week reflux group had a significantly lower global health status score than the low-frequency reflux group (59.6 ± 24.2 vs. 70.8 ± 20.7; P = 0.007). In addition, the ≥ once/week reflux group had a significantly lower social functioning score than the low-frequency reflux group (81.6 ± 24.1 vs. 88.4 ± 19.8; P = 0.035). Regarding symptoms, the ≥ once/week reflux group had significantly higher scores for fatigue, nausea, and vomiting, dyspnea and insomnia compared to the low-frequency reflux group (fatigue: 42.4 ± 21.9 vs. 28.9 ± 18.4, P < 0.001; nausea and vomiting: 17.3 ± 17.1 vs. 4.9 ± 10.6, P < 0. 001; dyspnea: 29.2 ± 26.0 vs. 21.7 ± 26.8, P = 0.043; insomnia: 22.2 ± 31.1 vs. 10.5 ± 21.7, P = 0.015). Thus, reflux after an esophagectomy was associated with a lower QOL.
在纵隔后部采用胃管道重建术进行食管癌切除术后出现的反流是一个具有临床意义的问题。在本研究中，我们使用一份原创问卷和欧洲癌症研究与治疗组织生活质量问卷第3.0版（EORTC QLQ-C30），调查了158例因食管癌接受食管切除术的患者中反流的频率及其对生活质量（QOL）的影响。使用原创问卷评估反流频率。每天、每周两到三次、每周一次或每周少于一次抱怨反流的患者人数分别为16例（10.1%）、21例（13.3%）、26例（16.5%）和60例（38.0%）。35例患者（22.2%）报告无反流症状。患者被分为两组：反流≥每周一次的患者（63例）和症状频率较低的患者（95例）。术后经过的时间是影响反流频率的唯一因素。反流频率在术后两年内下降；然而，两年多后频率趋于平稳。使用EORTC QLQ-C30评估生活质量。反流≥每周一次的组的总体健康状况评分显著低于低频反流组（59.6±24.2对70.8±20.7；P = 0.007）。此外，反流≥每周一次的组的社会功能评分显著低于低频反流组（81.6±24.1对88.4±19.8；P = 0.035）。在症状方面，反流≥每周一次的组在疲劳、恶心和呕吐、呼吸困难及失眠方面的评分显著高于低频反流组（疲劳：42.4±21.9对28.9±18.4，P < 0.001；恶心和呕吐：17.3±十七点一 对4.9±10.6，P < 0.001；呼吸困难：29.2±26.0对21.7±26.8，P = 0.043；失眠：22.2±31.1对10.5±21.7，P = 0.015）。因此，食管切除术后的反流与较低的生活质量相关。
