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目的评价食管胃胸内吻合联合肺减容手术(LVRS)对食管贲门癌合并重度肺气肿患者生活质量的影响。方法1998年6月至2004年3月,选取食管贲门癌合并重度肺气肿患者18例,其中食管癌15例、贲门癌3例,施行食管贲门切除、食管胃胸腔内吻合术,同时用直线形缝合切割器行同侧LVRS,根据术前影像学、术中所见及胸胃大小决定肺切除量。用SF36生活质量问卷表评价患者术前及术后3个月、6个月和12个月的生活质量,并进行比较。结果肺切除量约为单侧肺容量的25%～30%,切除重量为62.2g±9.6g。无手术死亡,术后平均住院19.7d±4.8d,恢复顺利。术后SF36生活质量表中所有指标均明显改善(P<0.05或P<0.01)。结论食管胃胸内吻合联合LVRS可显著地改善食管贲门癌合并重度肺气肿患者的生活质量。
Objective To evaluate the effect of esophagogastrostomy and lung volume reduction surgery (LVRS) on quality of life in patients with esophageal and cardiac cancer complicated with severe emphysema. Methods From June 1998 to March 2004, 18 patients with esophageal and cardiac cancer complicated with severe emphysema were selected, including 15 esophageal cancer patients and 3 cardia cancer patients. Esophageal and gastric cardia resection and esophagogastrostomy were performed. At the same time, Sutured cutter line ipsilateral LVRS, according to preoperative imaging, intraoperative findings and the size of the thoracic cavity to determine the amount of lung resection. The SF36 quality of life questionnaire was used to evaluate the patients’ quality of life before and 3 months, 6 months and 12 months after operation. Results The amount of lung resection was about 25% ~ 30% of unilateral lung volume and the removal weight was 62.2g ± 9.6g. No surgical death, the average postoperative hospital stay 19.7d ± 4.8d, recovery smoothly. All indexes of postoperative SF36 quality of life were significantly improved (P <0.05 or P <0.01). Conclusions Esophagogastric anastomosis combined with LVRS can significantly improve the quality of life of patients with esophageal and cardiac cancer complicated with severe emphysema.