经食管床与经胸骨后上提路径行管状胃食管吻合术后患者生活质量的比较研究

目的比较经食管床与经胸骨后两种上提路径行管状胃食管颈部吻合术后患者的生活质量。方法前瞻性纳入2008年7月至2012年6月问汕头市中心医院收治的、拟行食管癌切除术的167例患者，按随机数字表法随机分为食管床路径组（85例）和胸骨后路径组（82例）。分别于术后1、3、6、9及12月进行生活质量问卷调查。结果除吻合口狭窄发生率食管床路径组低于胸骨后路径组外（P〈0．05），两组患者围手术期一般情况的差异均无统计学意义（均P〉0．05）。149例患者完成了术后生活质量问卷调查，食管床路径组术后吞咽梗阻和吞咽干呕两项症状明显优于胸骨后路径组，但反酸和烧心两项症状则相对更严重（均P〈0．05）。两组患者总体生活质量评分的差异并无统计学意义（P〉0．05）。结论经食管床路径和经胸骨后路径行管状胃食管吻合术用于食管癌切除术后消化道重建均可获得较好的术后生活质量。前者术后吞咽功能优于后者，但反流症状却更为显著，因此，两种吻合方式各有利弊，应根据临床经验及患者情况进行选择。

Comparative study on the quality of life in patients with prevertebral or retrosternal reconstruction after cervical tubular gastroesophagostomy

Objective To compare the quality of life in patients with prevertebral or retrosternal reconstruction after cervical tubular gastroesophagostomy. Methods A total of 167 patients enrolled in this prospective study from July 2008 to June 2012 in Shantou Central Hospital, and divided into prevertebral route group（85 cases） and retrosternal route group（82 cases） according to the random number table method. Quality of life questionnaire was investigated 1, 3, 6, 9, and 12 months after operation respectively. Results The incidence of anastomotic stenosis was lower in the prevertebral route group （P〈0.05）. However, the differences in perioperative general conditions between the two groups were not statistically significant （all P〉0.05）. One hundred and forty-nine patients completed the postoperative quality of life questionnaire. Dysphagia and swallowing retching symptom were better, while acid reflux and heartburn symptom were more serious in prevertebral route group as compared to retrosternal route group （all P〈0.05）. Overall quality of life score difference between the two groups was not statistically significant （P〉0.05）. Conclusions For digestive tract reconstruction after resection of esophageal cancer, tubular gastroesophagostomy by prevertebral or retrosternal route both can obtain better quality of life after surgery. Swallowing function after surgery of the former is superior to the latter, but the reflux symptoms is more serious. Therefore the two mehods have their own advantages and disadvantages, and the choice of route should be depended on clinical experience and patient condition.