Nakada Koji, Kawashima Yoshiyuki, Kinami Shinichi, Fukushima Ryoji, Yabusaki Hiroshi, Seshimo Akiyoshi, Hiki Naoki, Koeda Keisuke, Kano Mikihiro, Uenosono Yoshikazu, Oshio Atsushi, Kodera Yasuhiro
Department of Laboratory Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama 362-0806, Japan.
World J Gastrointest Surg. 2021 May 27;13(5):461-475. doi: 10.4240/wjgs.v13.i5.461.
The effects of various gastrectomy procedures on the patient's quality of life (QOL) are not well understood. Thus, this nationwide multi-institutional cross-sectional study using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45), a well-established questionnaire designed to clarify the severity and characteristics of the postgastrectomy syndrome, was conducted.
To compare the effects of six main gastrectomy procedures on the postoperative QOL.
Eligible questionnaires retrieved from 2368 patients who underwent either of six gastrectomy procedures [total gastrectomy with Roux-en-Y reconstruction (TGRY; = 393), proximal gastrectomy (PG; = 193), distal gastrectomy with Roux-en-Y reconstruction (DGRY; = 475), distal gastrectomy with Billroth-I reconstruction (DGBI; = 909), pylorus-preserving gastrectomy (PPG; = 313), and local resection of the stomach (LR; = 85)] were analyzed. Among the 19 main outcome measures of PGSAS-45, the severity and characteristics of postgastrectomy syndrome were compared for the aforementioned six gastrectomy procedures using analysis of means.
TGRY and PG significantly impaired the QOL of postoperative patients. Postoperative QOL was excellent in LR (cardia and pylorus were preserved with minimal resection). In procedures removing the distal stomach, diarrhea subscale (SS) and dumping SS were less frequent in PPG than in DGBI and DGRY. However, there was no difference in the postoperative QOL between DGBI and DGRY. The most noticeable adverse effects caused by gastrectomy were meal-related distress SS, dissatisfaction at the meal, and weight loss, with significant differences among the surgical procedures.
Postoperative QOL greatly differed among six gastrectomy procedures. The severity and characteristics of postgastrectomy syndrome should be considered to select gastrectomy procedures, overcome surgical shortcomings, and enhance postoperative care.
各种胃切除术对患者生活质量（QOL）的影响尚未完全明确。因此，本研究采用胃切除术后综合征评估量表-45（PGSAS-45），在全国范围内开展了多机构横断面研究。PGSAS-45是一份成熟的问卷，旨在明确胃切除术后综合征的严重程度和特征。
比较六种主要胃切除术对术后生活质量的影响。
从2368例接受六种胃切除术之一的患者中收集合格问卷进行分析，这六种胃切除术分别为：Roux-en-Y重建全胃切除术（TGRY；n = 393）、近端胃切除术（PG；n = 193）、Roux-en-Y重建远端胃切除术（DGRY；n = 475）、毕罗一世重建远端胃切除术（DGBI；n = 909）、保留幽门胃切除术（PPG；n = 313）和胃局部切除术（LR；n = 85）。在PGSAS-45的19项主要结局指标中，采用均值分析比较上述六种胃切除术的胃切除术后综合征的严重程度和特征。
TGRY和PG显著损害术后患者的生活质量。LR术后生活质量良好（保留贲门和幽门，切除范围最小）。在切除远端胃的手术中，PPG的腹泻分量表（SS）和倾倒SS发生率低于DGBI和DGRY。然而，DGBI和DGRY术后生活质量无差异。胃切除术最明显的不良反应是与进餐相关的困扰SS、对进餐不满意和体重减轻，不同手术方式之间存在显著差异。
六种胃切除术的术后生活质量差异很大。选择胃切除手术时应考虑胃切除术后综合征的严重程度和特征，克服手术缺点，并加强术后护理。
