食管癌根治术式对远期呼吸功能的影响

食管癌根治术式较多 ,近年来手术术式较前已有所改进。这不仅提高了食管癌根治术的疗效 ,扩大了手术适应症 ,而且有效地改善了患者术后的生存质量。为探讨食管癌根治术不同术式对术后远期呼吸功能的影响 ,我们通过动态监测 ,对食管癌患者行食管胃主动脉弓上吻合、弓下吻合及经主动脉弓后胸膜顶吻合三种术式后的远期呼吸功能进行了观察及对比研究 ,现将结果报告如下。一、临床材料自 1998年 5月至 2 0 0 1年 5月 ,我院对食管癌患者行食表 1　弓上组、弓下组和弓后组手术前后各时点VC %、FEV1%和MVV %的比较 ( x±s)组别指标术前 术后3个…     

食管癌切除术后生存质量改变的研究

目的:探讨食管癌切除术后患者近期存活质量的改变及其与手术切除、淋巴结清扫范围的关系。方法:行食管癌根治手术存活一年以上的155例患者分为A组:89例行食管癌切除胸内食管胃吻合及两野淋巴结清扫术;B组:66例行食管癌切除食管胃颈部吻合及三野淋巴结清扫术。采用EORTC QLQ-C30及EORTC QLQ-OES24测评所有患者的生存质量。结果:与术前相比,出院时所有患者的生存质量均有所下降,在3月~12月之内逐渐恢复。两组间比较,整体健康状态、躯体功能及角色功能A组优于B组,存在显著差异(P<0.01)。结论:食管癌患者术后近期内生存质量明显下降,术后一年逐渐恢复;食管大部切除、食管胃颈部吻合加三野淋巴结清扫术较食管部分切除、胸内吻合及二野淋巴结清扫对患者躯体及角色功能等生存质量影响较大。     

改良管状胃代替食管对胸腹腔镜下食管癌根治术患者肺功能及术后并发症的影响

目的 探讨改良管状胃代替食管对胸腹腔镜下食管癌根治术患者肺功能及术后并发症的影响.方法 根据手术方式的不同将150例食管癌患者分为对照组(n=78)和改良组(n=72),对照组患者胸腹腔镜下食管癌根治术中给予管状胃代替食管,改良组患者胸腹腔镜下食管癌根治术中给予改良管状胃代替食管.比较两组患者的围手术期指标(手术时间、住院时间、术中出血量、术后肛门排气时间)、肺功能指标[第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、最大通气量(MVV)]及并发症发生情况.结果 改良组患者手术时间、住院时间均短于对照组(P﹤0.05),术中出血量低于对照组(P﹤0.05).术后1、3周,改良组患者FEV1、VC、MVV均明显高于对照组(P﹤0.01).改良组患者的并发症总发生率为9.72％,低于对照组患者的21.79％(P﹤0.05).结论 改良管状胃代替食管可缩短胸腹腔镜下食管癌根治术患者的手术时间、住院时间,降低并发症发生率、术中出血量,促进患者肺功能的恢复.     

食管胃颈部吻合与胃胸腔内吻合在中下段食管癌患者右胸入路根治术中的应用比较

目的研究食管胃颈部吻合与胃胸腔内吻合在中下段食管癌患者右胸入路根治术中的应用效果。方法选择73例患者作为研究对象,采用双盲法将其分为对照组(n=36)和观察组(n=37)。2组患者均进行右胸入路根治术,对照组实施胃胸腔内吻合,观察组实施食管胃颈部吻合。观察2组手术相关指标、术后并发症发生情况、术后3个月生活质量[简明健康生活状况量(SF-36)]以及3年生存率。结果2组手术用时、术中出血量、淋巴结清扫数量相比,差异无统计学意义(P>0.05);观察组术后放管时间、住院天数短于对照组,食管切除长度长于对照组,切端癌残留率低于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,但差异无统计学意义(P>0.05);术后3个月,2组SF-36各维度评分比术前高,且观察组高于对照组(P<0.05)。观察组术后1年生存率高于对照组,但差异无统计学意义(P>0.05);术后3年生存率高于对照组,差异有统计学意义(P<0.05)。结论中下段食管癌患者右胸入路根治术中应用食管胃颈部吻合,可扩大切除范围,降低切端癌残留率,利于术后恢复,并可有效提高术后生活质量和近期生存率。     

食管癌病人生活质量的纵向研究

目的　评价手术治疗和姑息性治疗对食管癌患者短期和长期生活质量的影响。方法　采用欧洲肿瘤治疗研究组织的肿瘤病人生活质量评价体系定期对 88例连续收治的食管癌病人生活质量进行测量 ,直至患者死亡或术后 3年。在测量的各个时点计算术后生存两年以上 (n =16 )、术后两年内死亡 (n =34)和姑息治疗 (n =38)这三组病人的各评价指标得分中位数。结果　接受手术治疗的一、二组病人术前在功能和症状性指标中得分相近。在食管癌根治术后 6周 ,患者在多数功能性指标中得分较术前低 ,而在症状性指标中得分较高 ,这说明手术后病人生活质量下降 ;但手术 9个月后 ,第一组病人生活质量显著改善并接近术前水平 ,而第二组病人除了吞咽困难症状外 ,生活质量无明显改善。选择作姑息性治疗的病人在治疗前的生活质量比接受手术治疗的一、二组病人差 ,但经治疗后其生活质量与二组病人相近。结论　食管切除手术对患者生活质量有着潜在的负面影响。对于生存两年以上病人这种影响是暂时的 ;对于两年以内死亡的病人 ,这种影响是不可逆的。从生活质量的观点出发 ,对中晚期的食管癌病人选择姑息治疗是合理的。     

胸腹腔镜联合根治术治疗老年食管癌患者的疗效及安全性分析

目的:探讨胸腹腔镜联合根治术治疗老年食管癌患者的临床疗效。方法:选取本院收治的老年食管癌患者64例,按手术方式将其分为开放组（n=29）及胸腹腔镜组（n=35）,分别行开放式食管癌根治术及胸腹腔镜联合食管癌根治术治疗。统计并比较两组患者手术情况,检测并比较术前及术后1周两组患者细胞免疫功能变化,术后定期随访1年,比较两组患者生存情况、复发情况、并发症发生情况及生活质量,并分析两组患者并发症情况相关因素。结果:与开放组比较,胸腹腔镜组患者手术时间、术后拔管时间、住院时间均显著缩短（P＜0.01）,手术切口显著减小（P＜0.01）,术中失血量、术后胸腔引流量均显著降低（P＜0.01）。与术前比较,术后1周两组全血CD4+ T淋巴细胞比例、CD4+/CD8+均显著降低（P＜0.05或P＜0.01）,且胸腹腔镜组显著高于开放组（P＜0.01）;术后1周胸腹腔镜组CD8+ T淋巴细胞比例较术前及开放组均显著降低（P＜0.05）。与开放组比较,胸腹腔镜组患者术后吻合口瘘发生率及总并发症发生率均显著降低（P＜0.05或P＜0.01）。随访期间胸腹腔镜组患者SF-36评分显著升高（P＜0.01）,而复发率显著降低（P＜0.05）;两组1年生存率比较无显著性差异（P＞0.05）。结论:胸腹腔镜联合根治术可有效减轻老年食管癌患者手术创伤,保护机体免疫功能,还可降低患者术后并发症,改善其生活质量,安全性良好。     

胃经食管床颈部吻合食管癌根治术对术后呼吸功能的影响

 目的　探讨胃经食管床颈部吻合食管癌根治术对患者术后呼吸功能的影响。方法　60例食管胸中段癌患者，30例行食管癌切除胃经食管床颈部食管胃吻合术，30例行胸内食管胃弓上吻合术，测量比较术前、术后3周、3个月肺功能主要指标变化。结果　患者均手术成功。颈部吻合组与胸内吻合组术前的肺活量（VC）、第1秒时间肺活量（FEV1）和最大通气量（MVV）差异均无统计学意义（P＞0.05）。术后3周、3个月两组相比VC、FEV1和MVV差异均有统计学意义（P＜0.05）。结论　经食管床行食管胃颈部吻合对患者呼吸功能影响小。     

食管癌病人生活质量的纵向研究

目的 评价手术治疗和姑息性治疗对食管癌患者短期和长期生活质量的影响。方法 采用欧洲肿瘤治疗研究组织的肿瘤病人生活质量评价体系定期对88例连续收治的食管癌病人生活质量进行测量，直至患者死亡或术后3年。在测量的各个时点计算术后生存两年以上(n=16)、术后两年内死亡(n=34)和姑息治疗(n=38)这三组病人的各评价指标得分中位数。结果 接受手术治疗的一、二组病人术前在功能和症状性指标中得分相近。在食管癌根治术后6周，患者在多数功能性指标中得分较术前低，而在症状性指标中得分较高，这说明手术后病人生活质量下降；但手术9个月后，第一组病人生活质量显著改善并接近术前水平，而第二组病人除了吞咽困难症状外，生活质量无明显改善。选择作姑息性治疗的病人在治疗前的生活质量比接受手术治疗的一、二组病人差，但经治疗后其生活质量与二组病人相近。结论 食管切除手术对患者生活质量有着潜在的负面影响。对于生存两年以上病人这种影响是暂时的；对于两年以内死亡的病人，这种影响是不可逆的。从生活质量的观点出发，对中晚期的食管癌病人选择姑息治疗是合理的。     

食管癌术后中西医综合治疗临床观察

目的探讨食管癌患者术后中西医综合治疗的生存率和生活质量.方法将食管癌术后病人随机分成中药+化疗治疗组和单纯化疗对照组.结果治疗组35例1、3、5年生存率分别为75.38%、37.71%和30.86%;对照组33例1、3、5年生存率分别为47.96%、22.27%和0;两组生存率有显著性差异(P＜0.05);中位生存期治疗组为36个月,对照组为16个月,中西医结合组患者生存质量和免疫状况均明显改善.结论食管癌术后中西医综合治疗可以提高生存率和生存质量,是一个值得推广的方法.     

不同手术方式对食管癌患者疗效及其预后的影响

目的 探讨手术方式差异对食管癌疗效及其预后的影响。方法 选取74例食管癌(中下段)患者作为研究对象,根据手术方式的差异将其分为2组。研究组患者40例,采用胸腹腔镜辅助McKeown食管癌根治术治疗;对照组患者34例,采用胸腔镜上腹-左颈切口McKeown食管癌根治术治疗。比较2组患者的临床疗效等差异。结果 研究组的术中失血量、腹腔引流时间、住院时间及术后进食时间均少于对照组(P<0.05),而其余方面比较2组无差别(P>0.05)。术后研究组的并发症发生率(12.5%)显著低于对照组(38.2%)(P<0.05)。术前2组患者的生活质量比较无差异(P>0.05),而术后研究组生活质量比对照组改善明显(P<0.05)。术后1年,2组患者的预后比较无差异(P>0.05)。结论 胸腹腔镜辅助McKeown食管癌根治术可显著提高中下段食管癌患者的疗效,同时可降低其术后并发症发生率,并改善其生活质量,且不影响患者的预后,值得临床推广应用。     

Quality of life after transhiatal compared with extended transthoracic resection for adenocarcinoma of the esophagus.

PURPOSE: To assess 3 years of quality of life in patients with esophageal cancer in a randomized trial comparing limited transhiatal resection with extended transthoracic resection. PATIENTS AND METHODS: Quality-of-life questionnaires were sent at baseline and at 5 weeks; 3, 6, 9, and 12 months; and 1.5, 2, 2.5, and 3 years after surgery. Physical and psychological symptoms, activity level, and global quality of life were assessed with the disease-specific Rotterdam Symptom Checklist. Generic quality of life was measured with the Medical Outcomes Study Short Form-20. RESULTS: A total of 199 patients participated. Physical symptoms and activity level declined after the operation and gradually returned toward baseline within the first year (P < .01). Psychological well-being consistently improved after baseline (P < .01), whereas global quality of life showed a small initial decline followed by continuous gradual improvement (P < .01). Quality of life stabilized in the second and third year. Three months after the operation, patients in the transhiatal esophagectomy group (n = 96) reported fewer physical symptoms (P = .01) and better activity levels (P < .01) than patients in the transthoracic group (n = 103), but no differences were found at any other measurement point. For psychological symptoms and global quality of life, no differences were found at any follow-up measurement. A similar pattern was found for generic quality of life. CONCLUSION: No lasting differences in quality of life of patients who underwent either transhiatal or transthoracic resection were found. Compared with baseline, quality of life declined after the operation but was restored within a year in both groups.     

Parent‐child communication patterns during the first year after a parent's cancer diagnosis

BACKGROUND:

Good parent‐child communication is thought to help families adjust more easily during stressful events such as parental cancer. Families dealing with cancer who communicate openly have reported less psychological distress. The first year after diagnosis may be particularly stressful. The authors investigated parents' quality of life (QOL) and stress‐response symptoms and parent‐child communication during the first year after diagnosis and examined possible relationships between communication and parents' functioning.

METHODS:

Recently‐diagnosed cancer patients (N = 70) and spouses (N = 55) participated within 4 months of diagnosis (T1) and 6 months (T2) and 12 months later (T3). Parents reported on communication with the children (PACS) and on their own physical and psychosocial functioning (RAND‐36) and stress‐response symptoms (IES).

RESULTS:

Parent‐child communication remained stable throughout the first year after diagnosis and was similar to communication in families 1 year to 5 years after diagnosis. Patients' functioning improved and cancer‐related distress decreased significantly. Spouses' cancer‐related distress decreased; their functioning fluctuated through the year. In concurrent analyses, patients' open communication with the children related only to T1 intrusion. Spouses' open communication related to T3 psychosocial functioning; problem communication related to T1 and T2 psychosocial functioning and T2 avoidance. In prospective analyses, no significant relationships were found between parent‐child communication and change in parents' functioning.

CONCLUSIONS:

Communication between parents and children remained stable over time; patients' and spouses' functioning improved. Parent‐child communication seems to have a limited affect on parents' functioning. Cancer 2009. © 2009 American Cancer Society.     

单纯后路经椎弓根椎体次全切除内固定联合人工椎体置换治疗胸腰椎转移瘤

目的 探讨单纯后路经椎弓根椎体次全切除内固定联合人工椎体置换治疗胸腰椎转移瘤的临床疗效.方法 2007年1月至2010年3月,对21例胸腰椎转移瘤进行单纯后路经椎弓根椎体次全切除、人工椎体置换及内固定术.男9例,女12例;平均年龄58岁(39～77岁).病变位于胸椎16例,腰椎5例.术前VAS评分平均7.4分(5～10分);术前Frankel脊髓功能分级:C级3例,D级6例,E级12例;术前ECOG功能分级2级1例,3级18例,4级2例.结果 所有患者无术中死亡,平均手术时间3.5h(2-5h).术中出血平均2150ml(800～5000ml).1例转移瘤患者术后2周死于多器官功能衰竭,20例患者术后VAS评分平均降至3.1分(1～4.5分),1例Frankel C级没有改变,1例C级改善为D级,6例D级均改善为E级.3例患者(14.3%)于术后半年至1年复发再次手术.最后一次随访时,20例患者平均随访13个月(3-24个月),其中13例患者死于原发疾病(平均生存10个月),其余存活患者ECOG功能分级为1～3级.结论 单纯后路经椎弓根椎体次全切除内固定联合人工椎体置换术减压充分,症状改善明显,可有效纠正脊柱后凸畸形,重建脊椎前后柱稳定性,改善骨转移瘤患者的生活质量.     

Microvascular radial forearm fasciocutaneous free flap in hard palate reconstruction.

THE AIM OF THIS STUDY: To report the reconstruction of palatal defects by microvascular radial forearm fasciocutaneous free flap (RFFF) and to report patient's quality of life outcomes after this procedure. MATERIAL AND METHODS: During the period 1990-2002, 30 cases of palatal defects were reconstructed using RFFF in our institution. RFFF allowed restoration of a vestibular sulcus to maintain dental prostheses. Outcome measurements included post-operative assessment of speech, swallowing and diet evaluation 6 months, 1 year and 2 years after reconstruction. Quality of life outcomes were measured 1 and 2 years post-reconstruction. RESULTS: RFFF surgery was successful in 28 cases. Six months after resection 28 patients reported satisfactory speech and swallowing. Two years after surgery, 92% (n=26) of patients resumed a normal diet. All patients underwent dental evaluation and 68% (n=19) of patients required dental rehabilitation over a post-operative period of 3-18 months. Patients self assessed their quality of life on a scale of 0-2. First year post-operatively, 21 patients reported a good quality of life (score=2). After the second year, 26 patients reported a good quality of life and the remaining two patients reported an intermediate quality of life (score=1) because they did not resume a normal diet. CONCLUSION: RFFF for palatal reconstruction is a reliable technique and provides a definitive separation between oral and sinusonasal cavities. Furthermore, it improves quality of life by improving speech, swallowing and chewing. It should be considered an integral component of head and neck cancer therapy and rehabilitation.     

A prospective study on quality of life of patients with cancer of the oral cavity or oropharynx treated with surgery with or without radiotherapy

The aim of this study was to describe prospectively quality of life and mood in patients with oral or oropharyngeal cancer treated with surgery +/- radiotherapy. Seventy-five patients completed the EORTC Core Questionnaire, the EORTC Head and Neck Cancer module and the Center for Epidemiologic Studies' Depression Scale before treatment and 6 and 12 months later. There was a significant deterioration of physical functioning, fatigue and almost all head and neck symptoms except pain, which improved. Patients with stage III/IV and patients receiving combined treatment had significantly worse physical symptoms compared to patients with stage I/II and patients treated with surgery only, respectively. Before and after treatment there was a high level of depressive symptomatology. However, after treatment a gradual improvement in emotional functioning occurred. Surgical treatment for oral or oropharyngeal cancer results in significant deterioration of physical functioning and symptoms during the first year, especially when combined with radiotherapy. Despite this, there is an improvement of emotional functioning after treatment, probably as a result of adaptation and coping processes.     

Restrictions in quality of life in colorectal cancer patients over three years after diagnosis: a population based study

Despite the burden and prevalence of colorectal cancer (CRC), there is only limited information regarding quality of life of patients who have survived beyond the first year post treatment. We assessed quality of life in a population-based cohort of 309 patients with CRC from Saarland (Germany) one and three years after diagnosis using the QLQ-C30 questionnaire and the tumour specific module QLQ-CR38. When compared with reference data from the general population, most patients with CRC reported high overall quality of life and only small deficits in physical functioning but deficits in emotional and social functioning persist over years in patients with colorectal cancer. Improvements in quality of life from the first to the third year after diagnosis in patients who remained free of disease were very modest and limited to less financial difficulties, a better future perspective and fewer stoma-related problems.     

Breast cancer survivors: Psychosocial concerns and quality of life

Purpose To describe the psychosocial concerns and quality of life of breast cancer survivors evaluated 2 and 3 years after primary treatment.Methods A sample of 139 breast cancer survivors who had been interviewed during the first year after primary treatment participated in a mailed survey at 2 years (N = 69) and 3 years (N = 70) after initial surgery. A random sample of these survivors were also interviewed in person. The mailed questionnaire included standardized instruments to assess quality of life (QL), rehabilitation needs, and psychological distress. Additional survey questions were developed to examine post-surgical recovery, employment and insurance problems. social support, and existential concerns. The in-person interviews expanded on these questions and systematically compared these patients' rehabilitation needs to those which existed at the time of an interview 1 year after surgery.Results The 2 and 3 year participants in this follow-up study did not differ from each other on their prior assessments with standardized QL instruments during the first year after surgery, nor did they differ from the full study sample of 227 women. The scores on the Profile of Mood States and the Functional Living Index-Cancer were the same for the 2 and 3 year survivor groups and did not differ from the previous assessments at 1 year after initial treatment. The scores on the Cancer Rehabilitation Evaluation System showed a significant decline in Global Quality of Life, Sexual Functioning and Marital Functioning between the 1 year and 3 year evaluations. For the 2 year sample only Sexual Functioning showed a deterioration between the 1 and 2 year evaluations. Using the RAND 36-Item Health Survey 1.0, the breast cancer survivors were compared with patients from the Medical Outcomes Study. The breast cancer survivors demonstrated higher levels of functioning in many dimensions (role functioning, social functioning, pain, and general health) than the patients with chronic medical conditions. In spite of relatively good physical and emotional functioning on this generic measure of health status and quality of life, these breast cancer survivors reported a number of important and severe rehabilitation problems that persisted beyond one year after primary treatment. Especially frequent were problems associated with physical and recreational activities, body image, sexual interest, sexual function, and problems with dating for those who were single.Conclusions Breast cancer survivors appear to attain maximum recovery from the physical and psychological trauma of cancer treatment by one year after surgery. A number of aspects of QL and rehabilitation problems worsen after that time. Nevertheless, breast cancer survivors rate their QL more favorably than outpatients with other common medical conditions, and they identify many positive aspects from the cancer experience.     

Long-term outcomes following minimally invasive and open esophagectomy in Finland: A population-based study

BackgroundStudies of long-term survival after minimally invasive and open esophagectomy are needed. The aim of this study was to compare long-term outcomes following minimally invasive and open esophagectomy for esophageal cancer at the population level.MethodsAll patients undergoing minimally invasive (n = 159) or open transthoracic (n = 431) esophagectomy for esophageal cancer in Finland between 2004 and 2014 were identified from nationwide registries. Propensity score matching was used to create groups of 150 minimally invasive and open esophagectomies with balanced baseline characteristics (sex, age, comorbidity, center volume, year of surgery, histology, stage (local or locally advanced), and neoadjuvant therapy). The primary outcome was 1-year survival after surgery. Secondary outcomes were the 3-year, 5-year, and 90-day survival.ResultsThe propensity matched 1-year survival rate was 85.3% after minimally invasive and 74.7% after open esophagectomy (adjusted HR 0.53, 95% CI 0.31–0.89; P = 0.0174). At 3 years, those were 68.7% and 55.6% (adjusted HR 0.62; 95% CI 0.43–0.91; P = 0.0144), respectively; at 5 years, survival rates were 61.8% and 51.9% (adjusted HR 0.68, 95% CI 0.47–0.97; P = 0.0347). The 30- and 90-day survival rates after minimally invasive and open surgery were 99.3% vs. 98.0% and 97.3% vs. 92.0%, respectively, without statistical significance.ConclusionsIn this population-based propensity matched study, minimally invasive esophagectomy was associated with improved long-term survival. Due to multiple confounding factors replication studies are needed.     

Quality of Life of Patients with Advanced Cervical Cancer before and after Chemoradiotherapy

Background: Cervical cancer is the most frequently diagnosed cancer among women in India. Understanding quality of life (QOL) in women undergoing chemoradiotherapy for cervical cancer will help in introducing interventions for better care and outcomes in these women. This study assessed QOL before and after chemo radiotherapy in cervical cancer patients. Materials and Methods: This followup study covered sixtyseven newly diagnosed women with advanced cervical cancer (stages 2b to 4b). Structured questionnaires (the European Organization for Research and Treatment of Cancer, EORTC QLQC30 and EORTC QLQCX24) were used to assess the change in QOL after 6 months of treatment. Results: The mean age of women at the time of detection of cervical cancer was 52.311.29 years (Range 3075 years). Six months survival was 92.53%. The mean global health score of cervical cancer patients after six months of treatment was 59.52, which was significantly higher than the pretreatment score of 50.15 (p0.00007). Physical, cognitive and emotional functioning improved significantly (p<0.05) after treatment. Fatigue, pain, insomnia and appetite loss improved but episodes of diarrhea increased after treatment. The mean "symptoms score" using EORTC QLQCX24 post treatment was 20.0 which was significantly lower as compared to the pre treatment score 30.0 (p<0.00001). Sexual enjoyment and sexual functioning decreased significantly after treatment. Conclusions: QOL of newly diagnosed cervical cancer patients improved significantly following chemoradio therapy. Enhancement was also demonstrated on three of the five functional scales of EORTC QLQC30. To further improve QOL, interventions focusing on social and psychological support and physical rehabilitation may be needed.