Article(id=1322929643078164630, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929547464815391, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.14.025, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1766332800000, receivedDateStr=2025-12-22, revisedDate=1781452800000, revisedDateStr=2026-06-15, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340605754, onlineDateStr=2026-10-30, pubDate=1784908800000, pubDateStr=2026-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340605754, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340605754, creator=13701087609, updateTime=1793340605754, updator=13701087609, issue=Issue{id=1322929547464815391, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='14', pageStart='2385', pageEnd='2576', issueExtLink='null', onlineDate='null', pubDate='1784908800000', pubDateStr='2026-07-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793340582958, creator='13701087609', updateTime=1793343111003, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940150912790807, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929547464815391, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940150912790808, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929547464815391, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2561, endPage=2565, ext={EN=ArticleExt(id=1322929643497595031, articleId=1322929643078164630, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Research progress on assessment tools for gastroesophageal reflux after esophageal cancer surgery, columnId=1220689485315101342, journalTitle=Chinese Nursing Research, columnName=Review Articles, runingTitle=null, highlight=null, articleAbstract=

This paper reviews the content,reliability,validity,and application of assessment tools for gastroesophageal reflux after esophageal cancer surgery.The aim is to provide a reference for the future development of specific assessment tools for gastroesophageal reflux after esophageal cancer surgery.

, authors=Quan MAO1, Fan WANG1, Haiwen ZHOU1, Jixiang BAI2, Shichun LU2, authorsList=Quan MAO, Fan WANG, Haiwen ZHOU, Jixiang BAI, Shichun LU, authorCompany=null, correspAuthors=Jixiang BAI, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322929646311973017, articleId=1322929643078164630, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=食管癌术后胃食管反流评估工具的研究进展, columnId=1220689485482873504, journalTitle=护理研究, columnName=科研综述, runingTitle=null, highlight=null, articleAbstract=

对食管癌术后胃食管反流评估工具的内容、信效度、应用情况等进行综述,以期为今后开发食管癌术后胃食管反流特异性评估工具提供参考。

, authors=毛权1, 王凡1, 周海雯1, 柏基香2, *, *, 陆世春2, authorsList=毛权, 王凡, 周海雯, 柏基香, 陆世春, authorCompany=null, correspAuthors=柏基香, authorNote=

毛权,硕士研究生在读

, correspAuthorsNote=
柏基香,E-mail:
BAI Jixiang, E-mail:
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毛权,硕士研究生在读

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毛权,硕士研究生在读

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食管癌术后胃食管反流评估工具的研究进展
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毛权 1 , 王凡 1 , 周海雯 1 , 柏基香 2, *, * , 陆世春 2
护理研究 | 科研综述 2026,40(14): 2561-2565
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护理研究 |科研综述 2026 , 40 (14) : 2561 -2565
食管癌术后胃食管反流评估工具的研究进展
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毛权1, 王凡1, 周海雯1, 柏基香2, *, * , 陆世春2
作者信息
  • 1扬州大学护理学院, 江苏 225001
  • 2江苏省苏北人民医院
通讯作者:
柏基香,E-mail:
BAI Jixiang, E-mail:
作者简介:

毛权,硕士研究生在读

Research progress on assessment tools for gastroesophageal reflux after esophageal cancer surgery
Quan MAO1, Fan WANG1, Haiwen ZHOU1, Jixiang BAI2 , Shichun LU2
Affiliations
  • 1School of Nursing, Yangzhou University, Jiangsu 225001 China
  • 2Northern Jiangsu People's Hospital
出版时间: 2026-07-25 doi: 10.12102/j.issn.1009-6493.2026.14.025
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对食管癌术后胃食管反流评估工具的内容、信效度、应用情况等进行综述,以期为今后开发食管癌术后胃食管反流特异性评估工具提供参考。

食管癌  /  胃食管反流  /  评估工具  /  综述

This paper reviews the content,reliability,validity,and application of assessment tools for gastroesophageal reflux after esophageal cancer surgery.The aim is to provide a reference for the future development of specific assessment tools for gastroesophageal reflux after esophageal cancer surgery.

esophageal cancer  /  gastroesophageal reflux  /  assessment tools  /  review
毛权, 王凡, 周海雯, 柏基香, 陆世春. 食管癌术后胃食管反流评估工具的研究进展. 护理研究, 2026 , 40 (14) : 2561 -2565 . DOI: 10.12102/j.issn.1009-6493.2026.14.025
Quan MAO, Fan WANG, Haiwen ZHOU, Jixiang BAI, Shichun LU. Research progress on assessment tools for gastroesophageal reflux after esophageal cancer surgery[J]. Chinese Nursing Research, 2026 , 40 (14) : 2561 -2565 . DOI: 10.12102/j.issn.1009-6493.2026.14.025
食管癌(esophageal cancer,EC)是一种常见的消化道恶性肿瘤。2022年全球流行病学数据显示,全球新诊断食管癌病例数为511 054例[1]。目前,食管癌的主要治疗方法仍然是手术治疗。随着微创食管切除术的不断发展和辅助治疗方法的进步,病人术后5年生存率提升至39.2%[2]。但手术相关并发症依然是影响病人术后生存质量的重要因素。胃食管反流是食管癌术后较常见的并发症之一,其发生率为38.4%~77.8%[3-4]。术后反流通常是由于手术破坏原有抗反流屏障和腹腔压力升高共同作用于吻合口所致[5],其临床表现主要为胃灼热感和胃内容物反流,可增加平卧位下吸入性肺炎发生风险,并可诱发反流性食管炎(reflux esophagitis,RE)及巴雷特食管,进而延缓病人康复进程,降低病人生活质量[6-7]。已有研究结果显示,术后出现反流的病人容易发生睡眠障碍及睡眠质量降低,也易出现健康相关生活质量(health-related quality of life,HRQOL)下降、功能受限以及症状加剧等问题[8-9]。随着病程延长,反流可提升再入院率,增加非侵入性或侵入性治疗需求,加重经济负担并消耗医疗资源。目前,国内外已有针对食管癌术后病人胃食管反流评估工具的研究,但评估工具的内容和选择性具有明显差异,在全面评估食管癌病人胃食管反流状况方面仍显不足。现对国内外食管癌术后胃食管反流评估工具的发展历程、评估内容、信效度和应用情况进行探讨与比较,以期为开发适用于我国食管癌术后胃食管反流病人的特异性评估工具提供参考。
胃食管反流是指胃内容物反流至食管所致的功能性障碍[10]。食管癌术后病人发生胃食管反流的风险显著增加,原因可能为手术过程破坏了胃食管连接处的正常结构和功能,导致机体抗反流屏障完整性受损[5]。同时,术中迷走神经损伤会干扰胃肠道蠕动与清除能力,延缓胃排空。此外,幽门痉挛可能导致胃内压力升高,进一步加剧反流[11]。术后胃的管状化形态改变以及其置于胸腔负压环境下的解剖位置使其易于扩张。在胸腹腔压力差作用下,可增加病人术后发生胃食管反流风险[12]。多种因素协同作用下导致食管癌术后病人胃食管反流发生率增高,降低其健康相关生活质量。因此,临床医护人员须高度重视术后反流病人,为其制定科学化、个性化、综合性的评估方案与护理策略。
RSI是由Belafsky等[13]于2002年开发的一种针对喉咽反流疾病(laryngopharyngeal reflux disease LPRD)的自我管理评估工具,可作为LPRD的初筛工具和LPRD病人治疗效果的辅助评估工具。该量表包含9个条目,每个条目均采用Likert 6级评分法,从“没有问题”到“严重问题”依次计0~5分,总分0~45分,>13分可判定为异常。Park等[14]采用RSI评估食管癌切除术病人的反流症状,确定了反流的患病率及其风险因素。郑杰元等[15]对RSI汉化并在107例咽喉疾病病人中进行验证,结果表明,量表的Cronbach's α系数为0.715,具有良好的信度和效度。目前,RSI已被翻译为多国语言并在多个国家得到了有效验证和使用,具有良好的普适性和跨文化适应性[16-17]。RSI易于实施和操作,填写负担较轻,但在我国食管癌术后病人临床实践与科研中的应用较少,尚未得到有效验证。
EORTC QLQ-OES 18是由Blazeby等[18]于2003年在核心量表欧洲癌症研究与治疗组织生活质量量表-核心问卷(EORTC QLQ-C30)的基础上研制,用于评估接受各种治疗的食管癌病人的生活质量。该量表进一步细化了食管癌病人的特异性症状,包括吞咽困难、进食、反流和疼痛4个分量表以及吞咽唾液、吞咽时呛咳、口干、味觉问题、咳嗽和言语问题6个单项条目。EORTC QLQ-OES 18通常与核心量表EORTC QLQ-C30联合使用,每个条目均采用Likert 4级评分法,从“完全没有”到“非常多”依次计1~4分,该量表各维度总分0~100分,得分越高表明症状越严重或功能、总体生活质量水平越高。Lagergren等[19]在食管切除术后反流病人中对EORTC QLQ-OES 18进行验证,证实量表反流条目具有有效性。李惠霞等[20]对112例食管癌病人进行EORTC QLQ-OES 18的汉化验证,结果显示,分量表的Cronbach's α系数为0.607~0.822,其中反流分量表的Cronbach's α系数为0.800,量表具有良好信效度。但EORTC QLQ-OES 18也存在一定不足,如反流分量表仅由2个条目构成,可能难以覆盖反流的全部表现,且该量表主要用于生活质量评估,在量表使用时,建议结合其他评估工具,以实现对术后病人胃食管反流状况的全面评估。
EORTC QLQ-OG 25是由Lagergren等[21]在EORTC QLQ-OES 18和欧洲癌症研究与治疗组织生活质量-胃癌模块(EORTC QLQ-STO 22)基础上于2007年研制。量表由6个症状分量表(吞咽困难、进食限制、反流、吞咽痛、疼痛和不适、焦虑)和10个与治疗相关的单项条目组成,其计分方法与EORTC QLQ-OES 18相同;经检验,反流症状分量表的Cronbach's α系数为0.64~0.73,具有良好信效度。EORTC QLQ-OG 25已被翻译成多国语言,其具有良好的跨文化普行性和适用性[22]。Lagergren等[8,23]将该量表应用于食管癌术后反流病人,以探究反流对病人术后睡眠质量、焦虑抑郁情绪等健康相关生活质量的影响。He等[3]将该量表应用于接受食管切除术后食管重建病人,以评估术后病人的饮食习惯、营养状况、胃肠症状以及生活质量。但EORTC QLQ-OG 25条目较多,填写过程烦琐、耗时,导致其临床应用有限,我国尚未检索到此量表的汉化版本,其应用研究尚处于初步阶段[24]。
EQOL是由Clifton等[25]于2007年为潜在可治愈性食管癌病人设计,量表可与核心量表EORTC QLQ-C30联合使用,旨在全面评估食管癌病人的生活质量,并能间接反映胃食管反流对病人生活质量的影响。EQOL由5个关键维度构成,涵盖了症状、身体功能、日常活动能力、情绪功能以及社会功能,量表主要关注反流、进食、嗳气等与病人健康相关的问题,共15个条目,采用Likert 7级评分法,量表原始得分在完成评定后会通过线性转换处理转化为0~100分的标准化分数,得分越高表明病人的生活质量水平越高。EQOL总体及各维度的Cronbach's α系数为0.73~0.90,表明量表具有良好的信效度[25]。目前,EQOL已在加拿大的研究中得以应用。但EQOL的反流条目场景单一、维度局限、缺乏治疗特异性和客观关联,且尚未检索到其汉化版本,故难以全面、精准地评估我国食管癌病人治疗后反流症状的真实情况以及对生活质量的影响。未来有待通过大样本、多中心的研究验证反流条目的敏感性和特异性。
DAUGS 32是由Nakamura等[26]于2008年研制,主要用于评估上消化道癌病人术后功能障碍程度。该评分系统涵盖反流症状、体力活动减少、吞咽功能障碍、倾倒综合征、恶心和呕吐等7个主题,采用区间量表评分(1~5分),得分越高表示功能障碍越严重;经检验,量表的Cronbach's α系数为0.924,表明量表具有较高的内部一致性。Yano等[27-28]将DAUGS 32应用于食管癌术后反流病人,以探讨手术方式改良对术后反流的影响,结果表明量表具有有效性和针对性。Huang等[29]将量表应用于食管癌切除术后消化道重建病人,以探讨食管切除和重建后的反流症状。但总体来看,DAUGS 32在我国的临床应用报道较少,其总体普适性仍需进一步研究。
ESQ是由Kwiatek等[30]于2011年基于已验证的特异性症状问卷[如癔球症症状评分(Glasgow-Edinburgh Throat Scale,GETS)、反流性疾病问卷(Reflux Disease Questionnaire,RDQ)等]修订合并而成,用于评估食管疾病病人常见的吞咽困难、癔球症、胃食管反流症状频率和严重程度,可为临床诊断流程优化和病人治疗管理提供综合性评估依据。该问卷包含30个条目,分为吞咽困难分量表(ESQ-D)、癔球症分量表(ESQ-G)、胃食管反流分量表(ESQ-R),涵盖食物吞咽、咽喉不适感、胸骨后灼烧感等症状维度,症状频率采用Likert 5级评分法,症状严重程度采用Likert 6级评分法,分量表总分通过各条目频率得分与严重程度得分乘积求和计算,满分为100分,得分越高表示症状越严重;经检验,该问卷的Cronbach's α系数为0.92,各分量表的Cronbach's α系数为0.89~0.93,问卷具有较好的内部一致性信度和结构效度。ESQ包含的条目清晰明了,具有良好的实用性,能够准确揭示病人当前最迫切需要干预的合并症,从而为制定有效的症状控制策略提供支持。但该问卷只有1/3的条目重测信度>0.70,且ESQ的反流分量表预测能力较差,条目设置可能未完全涵盖反流相关症状,其重测样本量较小,问卷暂无中文版本。未来需在多中心、大样本的临床场景中进一步研究验证。
食管重建后间歇性症状报告卡是由Lee等[31]于2018年开发的一种全面评估食管切除术后病人自我报告结局的工具,主要用于评估食管重建术后病人的健康相关生活质量和核心症状。量表包含吞咽困难、反流、倾倒综合征、疼痛和乳糖不耐症5个主要症状项目域以及身体和心理健康状况2个健康状况项目域。每个项目域满分均为100分,临床阈值依据具体条目内容设定,得分越高表示症状越严重。在反流症状评估方面,Lee等[32]建议将17.0分和50.1分分别作为良好-中度和中度-重度的临床阈值,该反流域包含8个问题,Cronbach's α系数为0.78,显示了良好的内容效度和心理测量学特性。食管重建后间歇性症状报告卡内容涉及广泛,能够对多种症状进行独立且可靠的量化评分,尤其是当病人的反流域得分显示存在中度-重度症状时,有利于医护人员制定精准的干预策略。但食管重建后间歇性症状报告卡开发时间较短,条目数量较多,用于我国食管癌术后反流症状评估的研究较少,普适性及适用性仍需进一步验证。
食管癌病人生存质量量表是由任国琴等[33]于2010年制定的适合我国食管癌病人的生存质量量表。量表由20个条目组成,包括主观症状与消化功能、身体机能、社会活动、精神心理4个方面,其中反流相关内容属于主观症状与消化功能维度,量表采用0~10分的计分方法,得分越高表示生存质量越高,反流条目得分越高提示食物反流症状越轻、生存质量越高;经检验,量表Cronbach's α系数为0.9438,量表具有可靠的信效度。食管癌病人生存质量量表既可用于食管癌病人的生命质量自我评估,还可辅助医务人员依据病情动态监测病人的胃食管反流状况,且适合我国食管癌病人群体,操作便捷、简单。但该量表反流相关指标覆盖不全,评估维度单一,症状分级简单,无法良好地区分反流严重程度,同时,量表量化精度不足、缺乏治疗相关性与人群特异性考量。在临床应用中,可将该量表用于术后反流症状的初步筛查,若需进一步精准评估术后反流情况,仍需结合其他评估工具使用。
食管癌症状评估量表由胡小冬[34]于2019年以不悦症状理论为指导,通过文献研究、病人及医护人员访谈、专家咨询构建。量表包括31个条目,涵盖进食困难、能量不足、胃肠道反应、反流-咳嗽、心理状况、化疗后神经毒性6个方面症状,每个症状均从症状出现频率、严重程度、困扰程度进行评价,其中,症状出现频率和严重程度均采用Likert 4级评分法,困扰程度采用Likert 5级评分法,得分越高表示病人症状水平越高;经检验,量表Cronbach's α系数为0.878,量表信效度良好,可作为临床症状评估工具。但食管癌症状评估量表的评估仅聚焦于术后化疗期间,反流条目设计单一,症状覆盖不全面,因子关联性与区分度不足,样本代表性不佳,推广性受限。未来仍需进一步开展多中心、大样本的临床验证,以优化反流相关维度设计。
食管癌术后病人胃食管反流自我管理行为量表由候莹鸽等[35]以自我管理理论为框架研制,用于评估食管癌术后病人胃食管反流的自我管理行为。量表包含疾病知识管理、情绪管理、饮食管理、生活行为管理4个维度,共31个条目,涵盖反流相关知识掌握、情绪调节、饮食控制及生活习惯调整等核心内容,采用Likert 5级评分法,从“完全不符合”到“完全符合”依次计1~5分,总分31~155分,得分越高表示病人术后反流自我管理能力越强;经检验,量表Cronbach's α系数为0.946,折半信度为0.614,重测信度为0.931,量表具有较好的信效度。食管癌术后病人胃食管反流自我管理行为量表反流条目针对性强,贴合临床核心需求,条目设计通俗易操作,适合食管癌术后病人。但该量表样本代表性不足,推广性受限,评估维度局限,未能直接评估反流症状严重程度。未来仍需在多中心、大样本研究中进一步验证,以优化条目针对性。
本研究梳理和总结了当前食管癌病人术后胃食管反流评估工具的研究进展,现有的食管癌术后胃食管反流评估工具多由国外开发和验证,尚未检索到被临床广泛应用和科学验证的特异性评估工具。部分评估工具侧重衡量病人术后的整体功能状态和生活质量,少数评估工具侧重于对部分反流症状进行评估,部分反流症状评估工具中反流条目设置单一,难以全面综合评估术后病人的反流情况。已有评估工具对于识别食管癌术后胃食管反流的敏感度和特异性还需进一步提高。未来研究应积极开发和验证本土化、适用于我国病人的多维度特异性评估工具,从而为食管癌术后病人提供更及时、准确的胃食管反流评估和管理,提升病人生活质量,改善病人预后。

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doi: 10.12102/j.issn.1009-6493.2026.14.025
  • 接收时间:2025-12-22
  • 首发时间:2026-10-30
  • 出版时间:2026-07-25
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  • 收稿日期:2025-12-22
  • 修回日期:2026-06-15
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    1扬州大学护理学院, 江苏 225001
    2江苏省苏北人民医院

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2种不同金属材料的力学参数
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genus
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species
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Percentage of
total species (%)
属
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Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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