| Objective:By comparing the effects 0f patients with Middle Thoracic esophageal cancer undergoing thoracoscopic and laparoscopic Mckeown Esophagectomy and traditional left thoracotomy Esophagectomy on the quality of life after operation,and then explore the safety and efficacy of the thoracoscopic and laparoscopic Mckeown Esophagectomy with esophageal carcinoma.Method:A total of 116 patients with Middle Thoracic Esophageal Carcinoma who were admitted to our hospital from march 2015 to January 2017 were enrolled in this study.In accordance with the surgical approach taken at the time of treatment were divided into two groups,thoracoscopic and laparoscopic Mckeown Esophagectomy 58 cases(minimally invasive Mckeown group),traditional left thoracotomy Esophagectomy 58 cases(traditional thoracotomy group)to analyze the postoperative clinical outcomes.The quality of life QLQ-C30 combined with esophageal cancer supplement scale QLQ-OES18 developed by the European Organization for Research and Treatment of Cancer(EORTC)was used to evaluate the Quality of Life,postoperative of the two groups at 1month,3months,6months,12 months.Results:The clinical data of two groups of patients,intraoperative blood loss,postoperative pulmonary infection was significantly different,anastomotic fistula,chylothorax,recurrent laryngeal nerve,arrhythmia,incision infection and other aspects were not statistically significant.less blood loss was found in the minimally invasive Mckeown group than in the traditional thoracotomy group [(171.1 ± 55.8)ml vs(260.5 ± 62.8)ml,P <0.05)],fewer pulmonary infection was found in the minimally invasive Mckeown group than in the traditional thoracotomy group [(6.8%,4/58)vs(20.6%,12/58),P <0.05].There was no significant difference in operative time,anastomotic fistula,chylothorax,recurrent laryngeal nerve injury,arrhythmia,and incision infection between the two groups.This study need to complete a total of 580 quality of life evaluation scale,the actual completion of follow-up and meet the requirements of the quality of life scale 559,the completion rate was 96.4%.Before operationg the overall quality of life score,the function Score and all symptom scores were not statistically significant.On the dimension of comprehensive quality of life: compared with preoperative,the overall quality of life of the two groups at 1 month,3 months and 6 months and the traditional thoracotomy group at 12 months were poor.The difference between the two groups was statistically significant.The peak value was at 1month after operation in thetraditional thoracotomy was significantly lower than that in minimally invasive Mckeown group.The overall quality of life of patients in the minimally invasive Mckeown group was significantly better than that in the conventional thoracotomy group at 1month,3months,6months and 12 months after surgery(P <0.05).The overall quality of life of patients in minimally invasive Mckeown group returned to preoperative baseline level at 12 months after surgery,but patients in the traditional thoracotomy group did not return to baseline at 12 months after surgery.Functional areas:(1)Body function:The score of minimally invasive Mckeown in the evaluation points at 1month,3months,6months and 12 months after operation was significantly higher than that of the traditional thoracotomy group(P <0.05).The scores of the minimally invasive Mckeown group returned to preoperative baseline at 12 months,but the patients in the traditional thoracotomy group did not return to the baseline level a12 months.Cognitive function and emotional function:(2)The scores of minimally invasive Mckeown group at 1month and 3months after operation were significantly higher than those in the traditional Thoracotomy group(P <0.05),The scores of both groups returned to preoperative baseline at 6 months.(3)Role function and social function:The scores of minimally invasive Mckeown group at 1month,3months and 6months after operation were significantly higher than those in the traditional Thoracotomy group(P <0.05),The scores of both groups returned to preoperative baseline at 12 months.In the symptom field: Minimally invasive Mckeown group and the traditional thoracotomy group in fatigue,nausea and vomiting,pain,insomnia,loss of appetite,diarrhea,dyspnea score and EORTC QLQ-OES18 Scale esophageal cancer gastroesophageal reflux symptoms,dry mouth,cough and other symptoms score was significantly higher than before surgery.However,dysphagia,eating choking and esophageal cancer-related pain symptoms score significantly lower than the preoperative baseline.Compared with the minimally invasive Mckeown group,the traditional Thoracotomy group had significantly higher fatigue,pain,dyspnea,cough difficulty and dry mouth scores at 1 month after operation(P <0.05).Compared with the traditional open-chest at 3 months,there was a significant difference in fatigue,pain,dry mouth,cough difficulty,dyspnea,cancer-related pain in minimal-invasive Mckeown group(P <0.05).Compared with the traditional Thoracotomy Group at 6months,there was a significant difference in fatigue,pain,cough difficulty(P <0.05).Compared with traditional thoracotomy group,the fatigue and pain scores were still significantly better in those of the minimally invasive Mckeown group at 12 months(P <0.05).Conclusions: 1.Minimally invasive Mckeown Esophagectomy in 12 months after surgery in overall quality of life,physical function,fatigue,pain,etc.is superior to the traditional left thoracotomy Esophagectomy.2.Compared with traditional left thoracotomy esophagectomy,minimally invasive Mckeown Esophagectomy with less trauma,less bleeding,fewer pulmonary complications,rapid recovery and good quality of life after surgery,etc.,worth the promotion in the clinical application. |
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