CAJ | 학술논문

目的评价胸腔镜和腹腔镜联合行食管癌切除,经胸骨后胃-食管颈部圆形吻合器吻合术与颈胸腹三切口食管癌切除术对患者术后生活质量的影响.方法南方医科大学南方医院胸心外科于2009年1月至2010年10月手术治疗63例胸部中上段食管癌患者,其中行胸腔镜和腹腔镜联合食管癌切除术33例(A组),颈胸腹三切口食管癌切除术30例(B组).采用欧洲癌症研究与治疗组织(EORTC)开发的生活质量核心量表QLQ-C30和食管癌补充量表QLQ-OES18评价患者术后的生活质量.结果两组患者一般资料的比较除吻合方式不同外,差异均无统计学意义(P>0.05).A组患者术后分别发生颈部吻合口瘘1例(3.0%,1/33)、颈部切口感染1例(3.0%,1/33)和吻合口狭窄1例(3.0%,1/33);B组发生吻合口瘘8例(26.7%,8/30),吻合口狭窄2例(6.7%,2/30),颈部切口感染1例(3.3%,1/30),肺部感染6例(20.0%,6/30);均经保守治疗后好转.A组患者术后在吞咽困难、进食、疼痛、梗阻、呼吸困难、食欲丧失、疲倦、经济困难、躯体功能、角色功能、情绪功能、认知功能、社会功能及总体健康状况维度方面的评分均优于B组,差异有统计学意义(P<0.05);其余维度差异无统计学意义.结论胸腔镜和腹腔镜联合食管癌切除术患者颈部器械吻合后并发症发生率低,生活质量明显优于颈胸腹三切口手术的患者.
목적 평개흉강경화복강경연합행식관암절제,경흉골후위-식관경부원형문합기문합술여경흉복삼절구식관암절제술대환자술후생활질량적영향.방법 남방의과대학남방의원흉심외과우2009년1월지2010년10월수술치료63례흉부중상단식관암환자,기중행흉강경화복강경연합식관암절제술33례(A조),경흉복삼절구식관암절제술30례(B조).채용구주암증연구여치료조직(EORTC)개발적생활질량핵심량표QLQ-C30화식관암보충량표QLQ-OES18평개환자술후적생활질량.결과 량조환자일반자료적비교제문합방식불동외,차이균무통계학의의(P>0.05).A조환자술후분별발생경부문합구루1례(3.0%,1/33)、경부절구감염1례(3.0%,1/33)화문합구협착1례(3.0%,1/33);B조발생문합구루8례(26.7%,8/30),문합구협착2례(6.7%,2/30),경부절구감염1례(3.3%,1/30),폐부감염6례(20.0%,6/30);균경보수치료후호전.A조환자술후재탄인곤난、진식、동통、경조、호흡곤난、식욕상실、피권、경제곤난、구체공능、각색공능、정서공능、인지공능、사회공능급총체건강상황유도방면적평분균우우B조,차이유통계학의의(P<0.05);기여유도차이무통계학의의.결론 흉강경화복강경연합식관암절제술환자경부기계문합후병발증발생솔저,생활질량명현우우경흉복삼절구수술적환자.
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%,l/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.