Clinical research of quality of life with nutritious and immune status after radical gastrectomy
10.3760/cma.j.issn.1674-635X.2012.04.005
- VernacularTitle:三种不同吻合方式胃癌根治术后患者生活质量及免疫营养状况调查
- Author:
Yuzhou ZHAO
;
Guangsen HAN
;
Yingkun REN
;
Chaomin LU
;
Yanhui GU
- Publication Type:Journal Article
- Keywords:
Stomach tumor;
Quality of life;
Nutrition;
Immune
- From:
Chinese Journal of Clinical Nutrition
2012;20(4):215-221
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the quality of life,nutritional status,and immune function after radical proximal gastrectomy,radical total gastrectomy,or radical distal gastrectomy.Methods Totally 163 patients underwent radical gastrectomy for gastric cancer in our department from Jun 2002 to Jun 2008,among whom 36 cases underwent proximal gastrectomy,and 78 cases underwent total gastrectomy,and 49 cases underwent distal gastrectomy.The indicators for their quality of life,nutritional status,and immune function were compared among these three groups.Results The scores for anxiety was significantly higher in the radical proximal gastrectomy group compared with radical total gastrectomy and radical distal gastrectomy groups 1 year(79.8 ± 4.3 vs 72.2 ± 5.2and 70.6±5.5,P=0.037)and 2 years(80.3 ±4.4 vs 70.2±4.8 and 68.6±5.3,P=0.041)after surgery.The scores for the sense of taste was significantly higher in the radical total gastrectomy group compared with radical proximal gastrectomy and radical distal gastrectomy groups 1 year(82.6 ± 1.3 vs 71.1 ±4.8 and 72.3 ± 3.6,P =0.033)and 2 years(88.1 ± 3.4 vs 65.6 ± 5.2 and 69.6 ± 4.8,P =0.046)after surgery.The scores for body appearance was significantly higher in the radical total gastrectomy group compared with radical proximal gastrectomy and radical distal gastrectomy group 0.5 years(45.5 ± 2.4 vs 35.6 ± 2.2 and 33.3 ± 2.5,P =0.031),1 year(49.2 ± 1.9 vs 33.2 ±2.8 and 32.7 ±2.3,P =0.039),and 2 years(47.6 ±2.5 vs 32.4 ±4.0 and 30.0 ± 2.2,P =0.025)after surgery.The scores for dysphagia was significantly lower in the radical distal gastrectomy group compared with radical proximal gastrectomy group and radical total gastrectomy group 1 year (26.6±3.0vs38.1±2.2 and 35.1 ±2.3,P=0.043)and 2 years(17.3±2.5 vs 36.3±3.1 and 34.1 ±2.4,P =0.021)after surgery.The scores for stomach pain was significantly higher in the radical proximal gastrectomy group compared with radical total gastrectomy 0.5 years(41.2 ± 3.3 vs 37.1 ± 2.5,P =0.039),1year(38.1±2.2vs35.1±2.2,P=0.023),2 years(36.3±3.1 vs 34.1±2.4,P=0.034)after surgery.Radical distal gastrectomy group were significantly lower than those in radical proximal gastrectomy group and radical total gastrectomy group 0.5 years(38.6 ± 3.7 vs 55.3 ± 4.2 and 42.3 ± 3.9,P =0.034),1 year(35.4 ± 3.4 vs52.3 ±3.9 and 39.3 ±4.2,P=0.040),and 2 years(31.6±3.7 vs 53.3 ±4.2 and 35.5 ±3.7,P=0.011)after surgery.Radical proximal gastrectomy group compared with radical total gastrectomy,0.5 years(55.3 ± 4.2vs 42.3±3.9,P=0.036),1 year(52.3±3.9 vs 39.3±4.2,P=0.042),2 years(53.3±4.2 vs 35.5±3.7,P =0.019)after surgery,the difference has statistically significant.The scores for hiccup was significantly lower in the radical distal gastrectomy group compared with radical proximal gastrectomy group and radical total gastrectomygroup,0.5 years(16.8±3.3 vs 45.6±2.5 and 40.3±2.8,P=0.019),1 year(15.6±3.4 vs 40.7±2.3 and 36.5 ± 3.1,P =0.025),2 years(14.4 ± 2.6 vs 39.3 ± 1.9 and 35.6 ± 3.2,P =0.042)after surgery.Radical proximal gastrectomy group compared with radical total gastrectomy 0.5 years(45.6 ± 2.5 vs 40.3 ± 2.8,P=0.039),1 year(40.7±2.3 vs 36.5±3.1,P=0.019),2 years(39.3±1.9 vs 35.6±3.2,P=0.028)after surgery,the difference has statistically significant.In the restricted diet,the radical distal gastrectomy group had significantly lower scores compared with radical proximal gastrectomy group and radical total gastrectomy group 0.5 years(22.4 ±3.8 vs 38.4 ±2.3 and 42.1 ±3.1,P=0.020),1 year(18.7 ±2.3 vs 35.3 ±3.2 and 36.8 ±3.4,P =0.018),and 2 years(16.5 ± 2.7 vs 33.4 ± 2.7 and 32.4 ± 2.8,P =0.026)after surgery.The level of albumin in different periods was significantly lower in radical total gastrectomy groups compared with radical proximal gastrectomy and radical distal gastrectomy group 0.5 years[(30.6 ± 2.5)vs(34.3 ± 2.6)and(35.4 ±2.5)g/L,P=0.025],1 year[(32.4±2.1)vs(35.3 ±2.2)and(38.9 ±2.0)g/L,P=0.041],2 years [(32.1 ±2.4)vs(36.4 ±2.1)and(42.4 ±2.3)g/L,P=0.016]after surgery.The level of prealbumin in different periods was significantly lower in radical total gastrectomy groups compared with radical proximal gastrectomy and radical distal gastrectomy group 0.5 years[(209.1 ±5.7)vs(218.2 ±5.9)and(225.5 ±7.6)mg/L,P =0.030],1 year[(215.5 ±4.6)vs(223.1±3.7)and(236.1 ±4.4)mg/L,P=0.019],2 years[(216.1 ±3.1)vs(221.5 ± 4.3)and(240.5 ± 5.6)mg/L,P =0.024)]after surgery.The level of transferrin in different periods was significantly lower in radical total gastrectomy groups compared with radical proximal gastrectomy and radical distal gastrectomy group 0.5 years[(153.1 ± 3.2)vs(167.9 ± 2.4)and(170.3 ± 3.8)mg/L,P =0.017],1 year[(157.1 ±3.8)vs(169.4±2.2)and(175.4±3.7)mg/L,P=0.040],2 years[(156.4±2.7)vs(173.1 ± 1.8)and(174.1 ±2.8)mg/L,P =0.031]after surgery.The level of hemoglobin in different periods was significantly lower in radical total gastrectomy groups compared with radical proximal gastrectomy and radical distal gastrectomy group 0.5 years[(109.5 ± 4.6)vs(120.2 ± 2.7)and(122.6 ± 3.9)g/L,P =0.016],1 year[(103.6±2.9)vs(117.5 ±16.6)and(125.2±1.5)g/L,P =0.030],2 years[(105.5 ±1.6)vs(106.6 ± 2.9)and(132.6 ± 2.9)mg/L,P =0.028]after surgery.The level of retinol binding protein in different periods was significantly lower in radical total gastrectomy groups compared with radical proximal gastrectomy and radical distal gastrectomy group 0.5 years[(32.3 ± 2.1)vs(167.9 ± 2.4)and(37.6 ± 2.8)mg/L,P =0.013],1 year[(33.9 ± 1.6)vs(39.3 ±2.5)and(38.5 ±3.5)mg/L,P=0.009],2 years[(35.3 ±2.7)vs(38.9 ± 1.4)and(39.1 ±2.3)mg/L,P =0.034]after surgery.The weight in different periods was significantly higher in radical distal gastrectomy groups compared with radical proximal gastrectomy and radical total gastrectomy group 0.5 years[(63.4±2.5)vs(60.7 ±3.2)and(59.4±1.1)kg,P=0.017],1 year [(66.1 ±3.7)vs(59.4±2.1)and(56.4±6.1)kg,P=0.028],2 years[(67.4 ±4.1)vs(57.4 ±4.1)and(53.3 ± 2.4)kg,P =0.035]after surgery.The level of CD4 + in different periods was significantly lower in radical total gastrectomy groups compared with radical proximal gastrectomy and radical distal gastrectomy groups 0.5 years(30.46 ±4.45 vs 33.32 ±5.6 and 34.24 ±2.54,P =0.036),1 year(32.84 ± 3.61 vs 35.30 ±4.27and 35.49±3.01,P=0.025),and 2 years(31.61±4.04 vs36.24±4.71 and 37.74±4.15,P=0.030)after surgery.Also,the radical total gastrectomy group had significantly lower CD8 + than radical proximal gastrectomy and radical distal gastrectomy groups 0.5 year(24.16 ± 5.07 vs 24.12 ± 5.9 and 25.25 ± 3.54,P =0.036),1 year(32.84 ±3.61 vs 35.30 ±4.27 and 35.49 ±3.01,P =0.025),and 2 years(31.61 ±4.04 vs36.24 ±4.71 and 37.74 ±4.15,P =0.030)after surgery.The level of IgM in different periods was significantly lower in radical total gastrectomy groups compared with radical proximal gastrectomy and radical distal gastrectomy group 0.5 year(1.20 ±0.17 vs 1.36 ±0.22 and 1.41 ±0.27,P =0.026),1 year(1.25 ±0.14 vs 1.38 ±0.19 and 1.40 ± 0.15,P =0.037),and 2 years(1.29 ± 0.17 vs 1.39 ± 0.16 and 1.42 ± 0.13,P =0.017)after surgery.Also,the radical total gastrectomy group had significantly lower IgA than radical proximal gastrectomy and radical distal gastrectomy groups 0.5 year(2.03 ± 0.21 vs 2.47 ± 0.32 and 2.43 ± 0.25,P =0.020),1 year(2.14 ±0.21 vs 2.64 ±0.23 and 2.52 ±0.17,P =0.025),and 2 years(2.25 ±0.19 vs 2.63 ±0.18and 2.74 ± 0.16,P =0.033)after surgery.Conclusion The distal gastrectomy may have better quality of life,nutrititional status,and immune function than the proximal gastrectomy and total gastrectomy,whereas the latter two procedures also have certain advantages.
