摘要: |
目的 比较细管状胃与宽管状胃对于食管癌患者术后生活质量的差异。方法 回顾性分析复旦大学附属中山医院胸外科数据库中登记的2018年1月至2019年12月间行微创食管癌切除术的651例临床早期食管癌患者,其中345例采用传统5 cm宽度的管状胃(宽管状胃组),306例采用改良的3 cm宽度的细管状胃(细管状胃组)。以患者临床资料作倾向配比,筛选出260对患者,分析其围手术期外科效果指标。采用欧洲癌症治疗研究组织发布的生活质量评分量表(EORTC QLQ C-30和OES-18量表)对两组患者的术前术后(3月、6月、9月、12月时)的生活质量进行评价),并采用重复测量方差分析进行比较。 结果 两组患者在年龄、性别、体重指数、合并疾病指数、麻醉风险分级、肿瘤部位和术后病理分期方面等临床特征方面的差异均无统计学意义,在出血量、术后住院天数、总体并发症发生率的差异均无统计学意义。细管状胃组的相关手术耗材费用较高(0.79±0.04万元 vs 0.58±0.05万元,p=0.000)。两组患者的生活质量各项指标在术前基线水平的差异均无统计学意义,而在术后有不同程度的恶化,但均随着时间的延长而逐渐改善。重复测量方差分析结果显示,除外时间效应,细管状胃组术后在整体状况评分、呼吸不适、反流症状、咳嗽症状等四项指标方面明显优于宽管状胃组,差异存具有统计学意义。 结论 采用细管状胃的食管癌患者术后生活质量更好。 |
关键词: 管状胃 食管癌切除术 生活质量 |
DOI:10.12025/j.issn.1008-6358.2021.20202729 |
分类号:R735.1 |
基金项目:对比不同宽度的管状胃在微创食管癌根治术中的临床效果的前瞻性随机对照研究-吴阶平医学基金会临床科研专项资助项目(320.6750.17522) |
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Evaluation on the quality of life in patients with different width of gastric?conduit reconstruction after esophagectomy: A propensity score matched comparison |
Ge Jiaojiao1, Ma Ke2, Wang Shuai2, Wang Hao2
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1.The sixth Medical Center of PLA General Hospital;2.Zhongshan Hospital, Fudan University
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Abstract: |
Objective: To compare the short-term quality of life(QOL) in patients with different width of gastric?conduit reconstruction after esophagectomy. Methods: A total of 651 patients who underwent minimally invasive three-incision esophagectomy from January 2018 to December 2019 were enrolled in this study. There were 345 patients underwent conventional wide gastric?conduit reconstruction (Group Wide) and 306 underwent narrow gastric?conduit reconstruction (Group Narrow) . The method of propensity score matching was used. And eventually 260 paired cases were matched from the cohort to do further statistical analysis. The questionnaire QLQ C-30 together with OES-18, developed by European Organization for Research on Treatment of Cancer were applied to evaluate the quality of life (QOL) of the patients before and 3, 6, 9, 12 months after surgery. The repeated?ANOVA?test was performed to do statistical analysis. Results: The two groups were comparable in patient demographics after matching such as age, sex, BMI, CCI, ASA grade, tumor location and pTNM Stage. No statistical difference was founded on the peri-operative outcomes, such as blood loss, postoperative hospital stay or morbidity between the two groups. However, the cost of surgical materials was higher in Group Narrow (7.9±0.4 thousand RMB vs 5.8±0.5 thousand RMB, p=0.000). The QOL scores in baseline were comparable and deteriorated after surgery, but improved gradually with the duration of time. The?result?of?repeated?ANOVA?analysis?revealed that, apart from time effect, the patients in Group Narrow had better scores on Dyspnoea Symptom, Coughing Symptom, Reflux Symptom, as well as Global QOL than Group Wide . Conclusion:The narrow gastric conduit reconstruction seems to have better QOL than conventional wide gastric conduit reconstruction. |
Key words: Gastric conduit Esophagectomy Quality of life |