食管癌病人不同治疗方式生活质量纵向研究

目的评价手术和姑息性治疗对食管癌病人短期和长期生活质量的影响。方法采用欧洲癌症研究与治疗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监测，直至术后3年或死亡。在监测的各个时点计算术后生存2年以上(16例)、术后2年内死亡(34例)和姑息治疗(38例)这3组病人的各评价指标得分中位数。结果接受手术治疗的两组病人术前功能和症状性指标得分相近。在食管癌根治术后6周，多数功能性指标得分较术前低，症状性指标得分较高，说明手术后病人生活质量下降；但手术9个月后，生存2年以上病人生活质量显著改善并接近术前水平，术后2年内死亡组病人除了吞咽困难症状外，生活质量无明显改善。姑息性治疗的病人治疗前生活质量比接受手术治疗的病人差，但经治疗后其生活质量与手术两组病人相近。结论食管切除手术对病人生活质量有着潜在的负面影响。对于生存2年以上病人这种影响是暂时的；对于2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，对中晚期食管癌病人选择姑息治疗是合理的。

A longitudinal study of evaluating the quality of life of esophageal carcinoma patients

Objective: To evaluate the impact of esophagectomy and palliative treatment on short term and long term quality of life (QL) in patients with esophageal cancer. Methods: 88 consective patients treated with radical esophagectomy or palliative treatment were scored by European organization of cancer research and treatment (EORTC), QLQ C30 measurement of QL before treatment and at regular intervals until death or 3 years after operation. The cases were divided into 3 groups and mean scores were obtained from each group. Patients surviving more than 2 years were classified as group 1, with group 2 surviving less than 2 years, and group 3 undergoing palliative treatment. Results: Baseline functional and symptomatic QL scores were similar before treatment in the first and second group, which were higher than scores from the third group. Six weeks after esophagectomy, patients reported worse functional, symptom and global QL scores than before treatment. In the first group, QL scores returned to preoperative level within 9 months. However, improved symptom of dysphagia the second group never regained their former QL scores apart from dysphagia improved after surgery. QL scores of the third group were similar to those of the second group after treatment. Conclusion: Esophagectomy might have a negative impact on patients QL. This effect was found to be transient in the first group but inreversible in the second group. It might seem reasonable for patients in late stage to be treated palliatively.