中国实用外科杂志

中国实用外科杂志

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全腹腔镜下经胸腔入路治疗SiewertⅡ型食管胃结合部腺癌可行性研究

刘天舟，马志明，刘晶晶，唐小欢，陈    超，朱甲明   

  1. 吉林大学第二医院胃肠外科，吉林长春130041
  • 出版日期:2017-10-01 发布日期:2017-10-11

  • Online:2017-10-01 Published:2017-10-11

摘要：

目的    探讨全腹腔镜下经胸腔入路治疗SiewertⅡ型食管胃结合部腺癌的可行性。 方法    回顾性分析2017年3-6月吉林大学第二医院胃肠外科行全腹腔镜下经胸腔入路行D2淋巴结清扫和消化道重建的4例SiewertⅡ型食管胃结合部腺癌病人的临床资料。均行近端胃切除，并行食管-管状胃消化道重建。结果    4例病人均顺利完成手术，无中转开腹手术。肿物直径为3~5 cm，侵及食管1~3 cm，手术时间为230~370 min，消化道重建时间为40~50 min，术中出血20~90 mL，排气时间为3~4 d，住院时间为8~14 d。无死亡病例，无明显术后并发症发生。随访截至2017-09-01，病人无明显食管反流、进食困难等并发症发生。结论    对SiewertⅡ型食管胃结合部腺癌行全腹腔镜下经胸腔入路淋巴结清扫和食管-管状胃消化道重建初步疗效观察显示安全可行，值得进一步探索和研究。

关键词: 全腹腔镜, 食管胃结合部腺癌, 近端胃切除, 经胸腔入路

Abstract:

Feasibility study of totally laparoscopic transthoracic approach to treat SiewertⅡ adenocarcinoma of the esophagogastric junction        LIU Tian-zhou，MA Zhi-ming，LIU Jing-jing，et al. Department of Gastrointestinal Surgery，the Second Affiliated Hospital of Jilin University，Changchun 130041，China
Corresponding author：ZHU Jia-ming，E-mail：zhujiaming75@sina.com
Abstract    Objective    To investigate the feasibility of totally laparoscopic transthoracic approach to treat SiewertⅡadenocarcinoma of the esophagogastric junction patients. Methods    Clinical and follow-up data of four patients who underwent totally laparoscopic transthoracic approach surgery(proximal gastrectomy, D2 lymph nodes dissection and esophageal-tubular reconstruction) in our department from March to June 2017 were analyzed retrospectively. Results  Four patients were successfully completed the operation, no conversion. The size of tumor was 3~5 cm，the length of esophageal invasion was 1~3 cm. The operation time was 230~370 min，the digestive tract reconstruction time was 40~50 min，the volume of intraoperative bleeding was 20~90 mL，the first flatus time was 3~4 d and the hospital stay was 8~14 d. The patients were followed up till 01-09-2017，no obvious esophageal reflux and eating difficulties happened. Conclusion    Totally laparoscopic transthoracic approach to treat SiewertⅡadenocarcinoma of the esophagogastric junction patients is safe and feasible.

Key words: totally laparoscopic surgery, adenocarcinoma of the esophagogastric junction, proximal gastrectomy, transthoracic approach