CAJ | 학술논문

目的：比较管状胃经胸骨后与食管床不同上提路径行食管胃颈部吻合术的临床效果与术后患者生活质量。方法回顾性分析2009年6月至2012年5月在本院胸外科行食管癌切除、食管胃颈部吻合术的87例患者围手术期临床资料及术后1、3、6、9、12个月的生活质量状况。生活质量评价采用调查问卷自评方式，从躯体、角色、情绪和社会功能及治疗相关症状等五个方面进行评价，重点评价消化道相关症状，共25个项目。结果两组患者术中出血量、手术时间、住院时间的差异无统计学意义（P>0.05）；经胸骨后与食管床路径术后吻合口瘘（15.2%/9.8%）、肺部感染（8.7%/17.1%）等并发症发生率的差异均无统计学意义（P>0.05）。在术后1、3、6个月时，经胸骨后路径者反酸症状轻于经食管床路径者，在术后1、6个月时，前者烧心症状轻于后者（P<0.05或P<0.01）。两组各时间点生活质量评价总分的差异均无统计学意义（P>0.05）。结论经胸骨后路径者术后早、中期胃食管反流症状轻于经食管床路径者。经胸骨后与食管床不同胃上提路径行食管胃颈部吻合术均是可行的消化道重建方式，应根据临床经验及患者情况选择手术方式。
목적：비교관상위경흉골후여식관상불동상제로경행식관위경부문합술적림상효과여술후환자생활질량。방법회고성분석2009년6월지2012년5월재본원흉외과행식관암절제、식관위경부문합술적87례환자위수술기림상자료급술후1、3、6、9、12개월적생활질량상황。생활질량평개채용조사문권자평방식，종구체、각색、정서화사회공능급치료상관증상등오개방면진행평개，중점평개소화도상관증상，공25개항목。결과량조환자술중출혈량、수술시간、주원시간적차이무통계학의의（P>0.05）；경흉골후여식관상로경술후문합구루（15.2%/9.8%）、폐부감염（8.7%/17.1%）등병발증발생솔적차이균무통계학의의（P>0.05）。재술후1、3、6개월시，경흉골후로경자반산증상경우경식관상로경자，재술후1、6개월시，전자소심증상경우후자（P<0.05혹P<0.01）。량조각시간점생활질량평개총분적차이균무통계학의의（P>0.05）。결론경흉골후로경자술후조、중기위식관반류증상경우경식관상로경자。경흉골후여식관상불동위상제로경행식관위경부문합술균시가행적소화도중건방식，응근거림상경험급환자정황선택수술방식。
Objective To compare clinical outcome and quality of life (QoL) after cervical esophago-gastric anastomosis with retrosternal and prevertebral gastric tube reconstruction. Methods Eighty-seven pa-tients underwent esophagectomy and cervical anastomosis between June 2009 and May 2012 were enrolled in the study. The clinical data and QoL at 1, 3, 6, 9, 12 months after operation were evaluated for analysis. QoL evalua-tion was conducted by self-assessment questionnaires, which focus on gastrointestinal-related symptoms and in-clude 25 items ranging five aspects such as physical, role, emotional and social functioning, and treatment-related symptoms. Results There were no significant differences between the retrosternal group (n=46) and the pre-vertebral group (n=41) with regard to the above items:operative bleeding, duration of operation and hospital stay, and postoperative complication, including anastomotic leak (15.2%/9.8%) and pneumonia (8.7%/17.1%). Re-garding the QoL investigation, patients in the retrosternal group were reported with significantly less regurgitation at 1, 3, 6 months after operation, while significantly less heartburn at 1, 6 months after operation (P<0.05 or P<0.01). QoL scores were low at 1 month, and slowly recovered at 6 months after surgery in both groups. There were no significant difference between two groups with regard to QoL score during postoperative period in 12 months. Conclusions Patients with retrosternal routes suffered less gastroesophageal reflux than prevertebral routes in early and medium stages after operation. Retrosternal and prevertebral routes for gastric tube reconstruc-tion are both acceptable methods in esophagectomy. Individualized reconstruction route should be considered based on clinical experience and patient’s condition.