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目的比较食管胃结合部腺癌(AEG)(Siewert分型Ⅱ/Ⅲ型)病人行近端胃切除(PG)与全胃切除(TG)术后生活质量的差异。方法回顾性分析2006年1月至2009年12月四川大学华西医院胃肠外科胃癌专业组AEG(Ⅱ/Ⅲ型)的资料,PG者行食管-残胃吻合,TG者行食管-单管空肠横结肠前Roux-en-Y重建。术后6个月后行电话随访,采用欧洲癌症研究和治疗组织生活质量问卷(QLQ)-C30和QLQ-STO22量表评估术后生活质量。结果 98例符合AEG(Ⅱ/Ⅲ型),随访期内死亡30例,失访8例,纳入分析PG组40例,TG组20例。两组病人的性别、年龄、肿瘤大小、TNM分期(AJCC6版)、术后住院时间等基线指标差异无统计学意义。TG组总体健康状况评分略优于PG组,但差异无统计学意义(P=0.072)。术后单项症状方面,PG组在反流症状,进食困难、进食限制、恶心呕吐、食欲下降、味觉改变、社交能力以及睡眠方面评分差于TG组(P<0.05);TG组呼吸困难症状评分差于PG组(P=0.027)。结论 AEG(Ⅱ/Ⅲ型)病人行全胃切除术后生活质量较近端胃切除为优,尤其在控制反流、改善食欲等方面优势更为明显。
Objective To compare the quality of life after proximal gastrectomy (PG) and total gastrectomy (TG) in patients with esophagogastric junctional adenocarcinoma (AEG) (Siewert type Ⅱ / Ⅲ). Methods The clinical data of AEG (type Ⅱ / Ⅲ) gastroenterology in West China Hospital of Sichuan University from January 2006 to December 2009 were retrospectively analyzed. Transverse colon before Roux-en-Y reconstruction. Six months after the operation, telephone follow-up was performed to assess postoperative quality of life with the European QLQ-C30 and QLQ-STO22 questionnaires. Results AEG (type Ⅱ / Ⅲ) was found in 98 cases. There were 30 deaths during the follow-up period and 8 cases were lost to follow-up. Forty patients in the PG group and 20 in the TG group were included in the analysis. There were no significant differences in the baseline indicators of gender, age, tumor size, TNM stage (AJCC6 version) and postoperative hospital stay between the two groups. The overall health score of TG group was slightly better than that of PG group, but the difference was not statistically significant (P = 0.072). In terms of individual symptoms, the PG group had worse scores on reflux symptoms, eating difficulties, eating restriction, nausea and vomiting, loss of appetite, taste changes, social skills and sleep than those in TG group (P <0.05). TG score of dyspnea symptom Worse than PG group (P = 0.027). Conclusion The quality of life after total gastrectomy in AEG (type Ⅱ / Ⅲ) patients is better than proximal gastrectomy, especially in controlling reflux and improving appetite.