早期癌症远端内镜和手术治疗对长期生活质量和功能的影响

中华消化内镜杂志 Pub Date : 2019-12-20 DOI:10.3760/CMA.J.ISSN.1007-5232.2019.12.004

L. Huang, Xi Wu, Xiao-hong Sun, Lili You, L. Zou, Yizhen Zhang, Rui-yong Liu, Zhifeng Wang

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引用次数: 0

摘要

目的研究内镜下黏膜下剥离术（ESD）对癌症远端早期患者的长期生活质量（QOL）和胃功能的影响，并与手术对照。方法选择1年前在北京协和医院接受ESD或手术切除的EGC患者进行随访。采用QLQ-C30、SF-36、EQ-5D及消化不良症状评定量表评定生活质量。采用5小时胃排空率评价远端胃功能。电子胃镜检查吻合口是否狭窄。根据切除时的年龄，对远端1/3胃ESD（EP）组和远端胃大部切除（SP）组进行1:1匹配，然后比较两组的生活质量和胃功能。结果EP组和SP组各25例。根据QLQ-C30，EP组认知功能评分为83.3（83.3,83.3），SP组认知功能得分为83.3,100.0（P=0.056）。两组患者出现症状（疲劳、恶心呕吐、疼痛、呼吸困难、失眠、食欲不振、便秘、腹泻和经济困难）的比例无统计学差异。两组间的EQ-5D和SF-36评分无统计学差异。根据消化不良症状评定量表，EP组56.0%的患者有烧灼感，但SP组只有28.0%的患者出现这种症状（P=0.054）。SP组20.0%的患者报告恶心，EP组只有4.0%的患者出现这一症状（P=0.084）。胃排空结果显示，EP组5小时胃排空率异常的患者比例为31.8%，胃镜检查结果显示，EP组有1例幽门狭窄，但5小时胃排空率正常。Sp组吻合口通畅。结论ESD和手术切除远端EGC对患者生活质量的长期影响相似。但胃远端ESD后长期胃排空功能可能下降。关键词：胃肿瘤；早期诊断；生活质量；内镜黏膜下剥离术

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Effects of endoscopic and surgical treatment for distal early gastric cancer on long-term quality of life and function

Objective To study the effects of endoscopic submucosal dissection(ESD) on long-term quality of life (QOL) and gastric function of patients with distal early gastric cancer (EGC), compared with those of surgery. Methods Patients with EGC who received ESD or surgical resection in Peking Union Medical College Hospital over 1 year ago were selected to be followed up. QLQ-C30, SF-36, EQ-5D and dyspeptic symptom rating scale were used to evaluate QOL. Five-hour gastric emptying rate was used to evaluate distal gastric function. Electronic gastroscopy was used to observe whether the anastomotic stoma was stenotic. According to the age at resection, 1 to 1 matching was performed between the distal 1/3 gastric ESD (EP) group and the distal subtotal gastrectomy (SP) group, and then the QOL and gastric function between the two groups were compared. Results Twenty-five patients were included in group EP and group SP respectively. According to QLQ-C30, the scores of cognitive function were 83.3 (83.3, 83.3) in group EP and 83.3 (83.3, 100.0) in group SP (P=0.056). The proportion of patients with symptoms (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea and financial difficulties) between the two groups were not statistically different. There was no statistical difference in the scores of EQ-5D and SF-36 between the two groups. According to dyspeptic symptom rating scale, 56.0% patients in group EPhad burning sensation, but only 28.0% in group SP had this symptom (P=0.054). 20.0% of patients in group SPreported nausea, while only 4.0% in group EP had this symptom (P=0.084). Gastric emptying results showed that the proportion of patients with abnormal 5-hour gastric emptying rate was 31.8% in group EP, while there was no abnormal emptying in group SP (P=0.003). Gastroscopy results showed that one patient in group EP had pyloric stenosis, but 5-hour gastric emptying rate was normal. All anastomotic stomas in group Sp were unobstructed. Conclusion ESD and surgical resection for distal EGC show similar long-term effects on QOL of patients. But the long-term gastric emptying function may decrease after distal gastric ESD. Key words: Stomach neoplasms; Early diagnosis; Quality of life; Endoscopic submucosal dissection

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来源期刊

中华消化内镜杂志

CiteScore

0.10

自引率

0.00%

发文量

7555

期刊介绍： Chinese Journal of Digestive Endoscopy is a high-level medical academic journal specializing in digestive endoscopy, which was renamed Chinese Journal of Digestive Endoscopy in August 1996 from Endoscopy. Chinese Journal of Digestive Endoscopy mainly reports the leading scientific research results of esophagoscopy, gastroscopy, duodenoscopy, choledochoscopy, laparoscopy, colorectoscopy, small enteroscopy, sigmoidoscopy, etc. and the progress of their equipments and technologies at home and abroad, as well as the clinical diagnosis and treatment experience. The main columns are: treatises, abstracts of treatises, clinical reports, technical exchanges, special case reports and endoscopic complications. The target readers are digestive system diseases and digestive endoscopy workers who are engaged in medical treatment, teaching and scientific research. Chinese Journal of Digestive Endoscopy has been indexed by ISTIC, PKU, CSAD, WPRIM.