Abstract: Application value of totally laparoscopic transabdominal hiatal approach in inferior mediastinal lymph node dissection of Siewert type Ⅱ adenocarcinoma of esophagogastric junction(AEG)        WANG Da-guang, LI Wei, ZHANG Yang, et al. Department of Gastrointestinal Surgery, the First Hospital of Jilin University,Changchun130021,China
Corresponding author：SUO Jian, E-mail: suojian0066@126.com
Abstract    Objective    To study the application value of totally laparoscopic transabdominal hiatal approach in inferior mediastinal lymph node dissection of Siewert typeⅡadenocarcinoma of the esophagogastric junction（AEG）. Methods    The retrospective and descriptive study was conducted. The clinicopathological data of 32 patients with Siewert type Ⅱ AEG who were admitted to Department of Gastrointestinal Surgery, The First Hospital of Jilin University from November 2018 to December 2019 were collected. Patients underwent lymph node dissection of AEG by totally laparoscopic transabdominal hiatal approach. With the esophagus as the center，No.110，No.111 and No.112 lymph nodes were dissected in the ventral—dorsal—bilateral clearance sequence. Operation time, intraoperative blood loss, number of lymph nodes dissected, the postoperative recovery time of intestinal peristalsis, postoperative intestinal exhaust time, and complications were recorded. Results    No.110，No.111 and No.112 lymph nodes were definitely dissected in the esophagus as the center，the ventral—dorsal—bilateral clearance sequence by totally laparoscopic transabdominal hiatal approach. No intraoperative secondary injury occurred，lymph node metastasis rate of No.110, No.111 and No.112 was 6.25%（2/32），9.38%（3/32） and 9.38%（3/32）, respectively.  Pleural effusion occurred in 21 cases, pancreatic fistula in 7 cases, abdominal infection in 1 case and anastomotic leakage in 1 case.  Conclusion    Totally laparoscopic transabdominal hiatal approach in the esophagus as the center，the ventral—dorsal—bilateral clearance sequence applied in the lymph node dissection is safe and feasible for the treatment of Siewert typeⅡAEG.

Key words: inferior mediastinal lymph node, Siewert type Ⅱ, adenocarcinoma of esophagogastric junction

摘要： 目的    探讨经食管裂孔下纵隔淋巴结清扫在SiewertⅡ型食管胃结合部腺癌（AEG）根治术中的应用价值。方法    回顾性分析吉林大学第一医院胃肠外科2018年11月至2019年12月间收治的32例经手术治疗的SiewertⅡ型AEG病人的临床资料，均采用腹腔镜下经食管裂孔途径，“以食管为中心按腹侧→背侧→两侧的清扫次序”清扫No.110、No.111、No.112淋巴结。记录病人的手术时间、术中出血量、收获淋巴结数量、术后肠蠕动恢复时间、术后排气时间、术后并发症等。结果    通过经食管裂孔途径，“以食管为中心按腹侧→背侧→两侧的清扫次序”实现了No.110、No.111、No.112淋巴结的确切清扫，淋巴结转移发生率No.110为6.25%（2/32），No.111为9.38%（3/32），No.112为9.38%（3/32）。无术中副损伤发生。术后出现胸腔积液21例，胰瘘7例，腹腔感染1例以及吻合口漏1例。结论    通过经食管裂孔途径，“以食管为中心按腹侧→背侧→两侧的清扫次序”对AGE病人进行下纵隔淋巴结清扫是安全可行的。

关键词: 下纵隔淋巴结, SiewertⅡ型, 食管胃结合部腺癌