中国实用外科杂志

中国实用外科杂志

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SiewertⅡ型食管胃结合部腺癌不同手术入路临床研究

朱    炬1，赵云平1，2，张    敏1，汲广岩1   

  1. 1重庆医科大学附属第一医院胸心外科，重庆400016；2陆军军医大学大坪医院胸外科，重庆400042
  • 出版日期:2018-04-01 发布日期:2018-03-30

  • Online:2018-04-01 Published:2018-03-30

摘要：

目的    探讨SiewertⅡ型食管胃结合部腺癌(AEG)的手术入路（经胸腹联合入路、经胸入路、经腹入路）选择及临床效果。方法    回顾性分析2013年10月至2015年10月陆军军医大学大坪医院及重庆医科大学附属第一医院收治的手术治疗的60例SiewertⅡ型AEG病人的临床资料。其中17例采取腹腔镜手术中联合左胸小切口（胸腹联合组）；22例采用左胸后外侧切口（经胸组）；21例实施腹腔镜手术（经腹组）。比较3组病例的胸腹腔清扫淋巴结情况、食管及胃切缘距离肿瘤长度、肺部并发症情况、术后住院时间、手术时间、术中出血量以及无进展生存期。结果    （1）胸腔清扫淋巴结数：胸腹联合组与经胸组差异无统计学意义（P>0.05），经腹组无法清扫胸腔淋巴结。（2）腹腔清扫淋巴结数：胸腹联合组多于经胸组（P<0.05）。（3）食管切缘长度：胸腹联合组大于经腹组（P<0.05）。（4）胃切缘长度：胸腹联合组大于经胸组（P<0.05）。（5）手术时间：经胸组较胸腹联合组短（P<0.05）。（6）术中出血量：胸腹联合组较经胸组明显减少（P<0.05）。（7）并发症：胸腹联合组未损伤膈肌，与经胸组相比肺部并发症发生率降低，住院时间明显缩短。术后随访示，胸腹联合组无进展生存期较经胸组和经腹组有所延长（P=0.048）。结论    采用腹腔镜联合左胸小切口有助于提高SiewertⅡ型AEG手术的根治性，减少手术的创伤和对呼吸循环系统的影响，病人康复更快。

关键词: 食管胃交界部腺癌, SiewertⅡ型, 淋巴结清扫, 手术入路

Abstract:

A clinical study of different operative approaches in treatment of Siewert typeⅡadenocarcinoma of esophagogastric junction        ZHU Ju*，ZHAO Yun-ping，ZHANG Min，et al. *Department of Thoracic and Cardiovascular Surgery，the First Affiliated Hospital of Chongqing Medical University，Chongqing 400042，China
Corresponding author：ZHAO Yun-ping，E-mail: zhaoypcq@126.com
Abstract    Objective    To investigate the best surgical approach of Siewert typeⅡ adenocarcinoma of esophagogastric junction(AEG) and effect of different approches. Methods    The clinical data of 60 patients with SiewertⅡ type AEG treated surgically from Daping Hospital of Chongqing and the First Affiliated Hospital of Chongqing Medical University from October 2013 to October 2015 were retrospectively analyzed. Among them, 17 patients were treated by  laparoscopy and thoracic small incision (combined thoracoabdominal approach group)，22 patients received left lateral thoracic incision (thoracic approachgroup)，and 21 patients underwent  laparoscopy (abdominal approachgroup). Thoracic and abdominal lymph node dissection，esophageal and gastric resection margin length，pulmonary complications，postoperative hospital stay，operation time，intraoperative blood loss and progression-free survival were compared. Results    Compared the combined thoracoabdominal approach group and thoracic approach group，the average number of lymph nodes of chest dissection showed no statistical significance，and it was unable to clear the chest lymph nodes in the abdominal approach group; in combined thoracoabdominal approach group the average number of abdominal lymph nodes was higher than thoracic approach group; esophageal margin length in the observation group was greater than the abdominal approach group; gastric resection margin length of the combined thoracoabdominal approach group was greater than the thoracic approach group; the time of operation thoracic approach group was shorter than the combined thoracoabdominal approach group，but combined thoracoabdominal approach group had less hemorrhage than thoracic approach group；with protect diaphragm，combined thoracoabdominal approach group decreased pulmonary complications compared to the thoracicapproach group，the time of hospital stay was significantly shorter. Combined thoracoabdominal approach group had longer PFS than thoracic approach group and abdominal approach group during follow-up. Conclusion    Laparoscopy and thoracic small incision helps improve the radical of Siewert typeⅡ AEG cancer surgery，reduce surgery trauma. It can reduce the impact on respiration and circulation，make it easier and faster for patients to recover.

Key words: adenocarcinoma of esophagogastric junction, Siewert typeⅡ, lymphadenectomy, operative approach