微创Sweet食管切除术治疗SiewertⅡ型食管胃交界腺癌近期生活质量分析

摘要

目的 探讨微创Sweet食管切除术对SiewertⅡ型食管胃交界腺癌患者术后近期生活质量的影响.方法 2015年1月至2017年9月,我科收治SiewertⅡ型食管胃交界腺癌患者120例,其中60例接受全腔镜微创Sweet食管切除术(MISE组),60例接受传统开放Sweet食管切除术(OSE组).采用欧洲癌症研究与治疗组织(EORTC)的QLQ-C30和QLQ-OES18评价量表问卷评估两组患者术前和术后1、2、4、8周生活质量.应用t检验和χ2检验比较两组患者临床病理特征、术中情况和术后并发症发生率.非正态分布资料采用Mann-Whitney检验.结果 两组患者术前基线、术后临床病理特征和手术时间差异无统计学意义(P＞0.05).微创组术中失血量低于开放组,差异有统计学意义[(88.1 ±32.2)ml对(119.5 ±34.1)ml,P＝0.001].微创组胸腔引流管留置时间低于开放组,差异有统计学意义[(8.1 ± 4.4)天对(10.5 ±4.0)天,P＝0.002].微创组术后住院日低于开放组,差异有统计学意义[(9.1 ±4.6)天对(11.6 ±3.8)天,P＝0.002].两组患者术后住院病死率、总并发症发生率差异无统计学意义(P＞0.05).微创组肺部并发症发生率低于开放组,差异有统计学意义(8.5%对22.7%,P＝0.044).微创组住院总费用高于开放组,差异有统计学意义[(54 106 ±4 352)元对(51 143 ±5 315)元,P＝0.001].两组患者术后躯体功能、角色功能、情绪功能和总体健康水平4个维度生活质量均较术前降低.其中开放组下降更为明显,两组患者术后1、2、4、8周得分均值差异均有统计学意义(P＜0.05).两组患者术后疼痛、疲劳和反酸均较术前升高.其中开放组升高更为明显,两组患者术后1、2、4、8周得分均值差异均有统计学意义(P＜0.05).结论 完全胸腔镜联合腹腔镜施行微创Sweet食管切除术治疗早中期SiewertⅡ型食管胃交界腺癌安全可行,相对于传统开放手术,该术式能够明显改善患者术后近期生活质量.%Objective To observe the impact of minimally invasive Sweet esophagectomy on short term quality of life for patients with Siewert typeⅡesophagogastric junction adenocarcinoma.Methods From January 2015 to September 2017, 60 patients underwent minimally invasive Sweet esophagectomy(MISE group) and 60 patients underwent open sweet esophagecto-my(OSE group).The questionnaires(EORTC QLQ-C30 and QLQ-OES18) were applied to assess the quality of life of the pa-tients before and 1,2,4,8 weeks after operation.The clinicopathologic factors, operational factors and postoperative complica-tions of the two groups were compared by t test and χ2test.The Mann-Whitney test was used to test for statistical significance because the responses were not normally distributed.Results The two groups were similar in terms of clinical characteristics and preoperative QOL scores(P ＞0.05).The MISE group was associated with a significant decrease in surgical blood loss [(88.1 ±32.2)ml vs.(119.5 ±34.1)ml, t＝5.052, P＝0.001], chest tube duration[(8.1 ±4.4)d vs.(10.5 ±4.0)d, t＝3.110, P＝0.002] and postoperative stay[(9.1 ±4.6)d vs.(11.6 ±3.8)d, t＝3.167, P＝0.002] relative to the OSE group.The postoperative in-hospital mortality and total morbidity did not differ between the two groups (P＞0.05).The MISE group was associated with significantly fewer respiratory complications than the OSE group (8.5%vs.22.7%, t＝4.063, P＝ 0.044).The MISE group was associated with a significant increase in hospitalization costs [(54 106 ±4 352) yuan vs. (51 143 ±5 315)yuan, P＝0.001] relative to the OSE group.MISE group gained higher scores in physical function, role func-tion, emotional function, Global QOL and lower scores in pain, fatigue, acid reflux than OSE group after surgery.Conclusion Our minimally invasive technique for Siewert typeⅡesophagogastric junction adenocarcinoma can be safely and effectively performed with favorable early outcomes.Compared to conventional open Sweet approach, MISE impoved the short term quality of life after surgery.