中国实用外科杂志

中国实用外科杂志

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腹腔镜辅助根治性全胃切除术治疗SiewertⅡ、Ⅲ型胃食管结合部腺癌疗效分析

陈起跃，吕陈彬，郑朝辉，李    平，谢建伟，王家镔，林建贤， 陆    俊，曹龙龙，林    密，涂儒鸿，黄昌明   

  1. 福建医科大学附属协和医院胃外科，福建福州350001
  • 出版日期:2016-09-01 发布日期:2016-08-24

  • Online:2016-09-01 Published:2016-08-24

摘要：

目的    探讨腹腔镜辅助根治性全胃切除术（LATG）治疗Siewert Ⅱ、Ⅲ胃食管结合部腺癌（AEG）病人的临床疗效。方法    回顾性分析2008年12月至2013年6月福建医科大学附属协和医院收治的418例行根治性全胃切除的Siewert Ⅱ、Ⅲ型AEG病人的临床资料，其中腹腔镜手术（LATG组）342 例，开放手术（OTG组）76例。比较两组病人近、远期疗效。结果    两组病人的一般资料及临床病理学资料对比差异均无统计学意义。与OTG组相比，LATG组术中失血少、手术时间短、进食半流质时间短及术后住院天数少，而两组并发症发生率差异无统计学意义。LATG 组的3年总体存活率高于OTG组（71.1% vs. 61.1%，P=0.033）；分层分析显示，Siewert Ⅱ型中，LATG 组3年总体存活率明显高于OTG组（79.5% vs. 69.1%，P=0.010）；而Siewert Ⅲ型中，两组3年总体存活率差异无统计学意义（P=0.315）。通过COX比例风险模型分析显示，手术入路、肿瘤TNM分期是影响Siewert Ⅱ型AEG病人预后的独立危险因素（P＜0.05）。结论    相较于OTG，LATG治疗 Seiwert Ⅱ、Ⅲ型AEG具有更好的近期疗效，是一种安全、可行的术式；对于Siewert Ⅱ型病人，LATG总体预后更好。

关键词: 胃食管结合部腺癌, Siewert分型, 腹腔镜, 根治性全胃切除术

Abstract:

Surgical outcomes after laparoscopic-assisted radial total gastrectomy for Siewert type Ⅱ and type Ⅲadenocarcinoma of the esophagogastric junction        CHEN Qi-yue，LÜ Chen-bin，ZHENG Zhao-hui, et al. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
Corresponding author: HUANG Chang-ming, E-mail：hcmlr2002@163.com
Abstract    Objective    To investigate the oncologic efficacy of laparoscopic-assisted radial total gastrectomy （LATG） for Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction (AEG). Methods    The clinicopathalogical data of 418 patients with Siewert type Ⅱ and Ⅲ AEG who had undergone radical total gastrectomy between December 2008 and June 2013 in Fujian Medical University Union Hospital were analyzed retrospectively. The short and long term outcomes were compared between the LATG (n=342) and opened radial total gastrectomy （OTG） (n=76) groups. Results The clinicopathological characteristics between the two groups had no statistical difference. LATG compared with OTG was associated with shorter operative time，less blood loss，shorter time to the resumption of a semi-fluid diet and shorter hospital stay. However, postoperative complication rates between the two groups had no significant difference. The 3-year overall survival rate in the LATG group was significantly higher than that in the OTG group  (71.1% versus 61.1%；P=0.033). In stratified analysis according to Siewert classification，the LATG group demonstrated significantly higher 3-year overall survival rate (79.5%versus 69.1%；P=0.010) for Siewert type Ⅱ AEG compared with the OTG group；however，in the Siewert type Ⅲ AEG subgroup，the 3-year overall survival rates were similar (P=0.315). COX proportional hazards regression model indicated that the surgical approach and TNM stage were independent prognostic factors affecting the whole group（P<0.05）. Conclusion    LATG is a safe and feasible procedure with better short-term outcomes for Siewert type Ⅱ and Ⅲ AEG. For Siewert type Ⅱ AEG particularly，LATG may yield better long-term survival.

Key words: adenocarcinoma of the esophagogastric junction, Siewert classification, laparoscopy, radical total gastrectomy