CAJ | 학술논문

目的观察食管扩张术联合吞咽训练治疗食管癌、贲门癌术后食管吻合口狭窄的疗效及对患者生活质量的影响.方法将135例术后食管吻合口狭窄患者随机分为治疗组及对照组.2组患者均于胃镜指导下应用萨氏扩张器进行食管扩张手术治疗,治疗组在此基础上辅以吞叫训练,每天训练2组吞咽活动,每组10～20次.于治疗前及治疗2、4、8周时检查并记录2组患者进食及吻合口直径变化情况,同时采用SF-36量表对2组患者生活质量进行评定.结果 2组患者治疗后其进食功能均有不同程度改善,其中Ⅰ级狭窄患者吻合口直径组间差异无统计学意义(P>0.05);Ⅱ级狭窄及Ⅲ级狭窄患者吻合口直径组间差异均有统计学意义(P<0.05),并以治疗组的改善幅度及疗效持续时间较显著;对2组Ⅱ级及Ⅲ级狭窄患者SF-36量表评分结果比较后发现,治疗后2组患者生活质量均有一定程度改善(P<0.05),且以治疗组的改善幅度较显著,与对照组比较,组间差异具有统计学意义(P<0.01).结论食管狭窄扩张术联合吞咽训练能进一步巩同扩张疗效,延缓吻合口发生再狭窄时间,从而改善患者进食功能,促使生活质量提高,并且该联合疗法具有安全、有效、操作简单等特点,值得临床推广应用.
목적 관찰식관확장술연합탄인훈련치료식관암、분문암술후식관문합구협착적료효급대환자생활질량적영향.방법 장135례술후식관문합구협착환자수궤분위치료조급대조조.2조환자균우위경지도하응용살씨확장기진행식관확장수술치료,치료조재차기출상보이탄규훈련,매천훈련2조탄인활동,매조10～20차.우치료전급치료2、4、8주시검사병기록2조환자진식급문합구직경변화정황,동시채용SF-36량표대2조환자생활질량진행평정.결과 2조환자치료후기진식공능균유불동정도개선,기중Ⅰ급협착환자문합구직경조간차이무통계학의의(P>0.05);Ⅱ급협착급Ⅲ급협착환자문합구직경조간차이균유통계학의의(P<0.05),병이치료조적개선폭도급료효지속시간교현저;대2조Ⅱ급급Ⅲ급협착환자SF-36량표평분결과비교후발현,치료후2조환자생활질량균유일정정도개선(P<0.05),차이치료조적개선폭도교현저,여대조조비교,조간차이구유통계학의의(P<0.01).결론 식관협착확장술연합탄인훈련능진일보공동확장료효,연완문합구발생재협착시간,종이개선환자진식공능,촉사생활질량제고,병차해연합요법구유안전、유효、조작간단등특점,치득림상추엄응용.
Objective To assess the therapeutic effect and quality of life (QOL) of patients with anastomotic stenosis after bougienage of esophagus following resection of esophagus with esophageal and of cardiac carcinoma.Methods A total of 135 patients suffering from anastomotie stenosis after resection operations were divided into a treatment group and a control group at random. All patients were given an esophageal dilator under gastroseope. In treatment group, deglutition training was given additionally, twice daily, 10 to 20 trials in each session. Therapeutic effect was evaluated according to patients' food intake and gastroscopy results of diameter of stenosis before treatment and 2,4,8 weeks after treatment. QOL was evaluated with Chinese version of SF-36 instrument. Results The food intake of all the patients improved. There was no difference of diameter of stenosis in degree Ⅰ stenosis patients be-tween two groups (P > 0.05 ) ; but the differences were statistically significant in degree Ⅱ and Ⅲ stenosis patients (P < 0.05). In treatment group, the degree and duration of improvement were more obvious. QOL of patients with degree Ⅱ and Ⅲ stenosis in both groups improved significantly after treatment ( P < 0.05 ), but compared with con-trol group the improvement was significantly greater in treatment group (P < 0.05). Conclusion The therapeutic effect of bougienage of esophagus can be strengthened with deglutition training. This combinative therapy is safe and effective.