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目的探讨不同的根治手术方式对胃癌患者术后生活质量的影响。方法对89例行胃癌根治术的患者,根据Spitzer生活质量总体评分量表及Chew-wunWu的特殊症状量表,按不同的胃切除范围(全胃切除、胃次全切除)和淋巴结清扫方式(D2、D3,4)及有无合并脏器切除等分组,在相同时期内进行生活质量的调查及评估。结果89例患者中,术前每组间各项指标差异无显著性意义。在全胃切除(TG)(37例)及胃次全切除(STG)(52例)组中,总体评分及特殊症状评分差异均无显著性意义。D2式淋巴结清扫组(75例)总体评分优于D3,4组(14例)(P<0.05);术后6个月,D3,4组患者腹泻发生率较D2组增多(P<0.05);体重减轻方面,D2组于术后1、3、6个月明显优于D3,4组(P<0.05)。无合并脏器切除组(33例)于术后12个月总体评分、饮食类型、进食量及进餐时间明显优于合并脏器切除组(19例)(P<0.05)。结论全胃或胃次全切除术后的QOL差异无显著性意义;淋巴结清扫范围与术后QOL密切相关,清扫范围越大,术后QOL越差;合并脏器切除对术后QOL有负影响。
Objective To investigate the effect of different radical operation methods on postoperative quality of life of gastric cancer patients. Methods Eighty-nine patients undergoing radical gastrectomy were divided into two groups according to the Spitzer Quality of Life Scale and the Chew-wunWu Special Symptom Scale, according to different gastrectomy range (total gastrectomy, subtotal gastrectomy) and lymph node dissection D2, D3, and 4), and the presence or absence of combined organ resections. The quality of life was investigated and evaluated during the same period. Results Among the 89 patients, there was no significant difference in every index between the two groups before operation. In total gastrectomy (TG) (37 cases) and subtotal gastrectomy (STG) (52 cases), there was no significant difference between the overall score and the special symptom score. The overall score of D2 lymph node dissection group (75 cases) was better than that of D3 and 4 groups (14 cases) (P <0.05). At 6 months after operation, the incidence of diarrhea in D3 and 4 groups was higher than that in D2 group (P <0.05) In terms of weight loss, D2 group was significantly better than D3 and 4 groups at 1, 3 and 6 months after operation (P <0.05). The total score, diet type, food intake and mealtime in the non-combined organ resection group (33 cases) at 12 months after surgery were significantly better than those in the combined organ resection group (19 cases) (P <0.05). Conclusions There is no significant difference in QOL after total or subtotal gastrectomy. The range of lymph node dissection is closely related to postoperative QOL. The larger the scope of clearance, the worse postoperative QOL. The combined organ removal has a negative effect on postoperative QOL .