俯卧位胸内手工吻合在食管受累≥4 cm的食管胃结合部腺癌中的应用

Application of intrathoracic hand-sewn anastomosis in prone position for adenocarcinoma of esophagogastric junction with esophageal involvement over 4 cm

目的探讨俯卧位胸内手工吻合治疗食管受累≥4 cm的食管胃结合部腺癌(adenocarcinoma of esophagogastric junction, AEG)的可行性。方法采用回顾性病例系列研究的方法,收集2019年3月至2020年12月期间,在郑州大学第一附属医院胃肠外科接受俯卧位完全微创食管胃胸内手工吻合的28例AEG患者的临床资料,分析手术情况和近期疗效等。结果28例患者均顺利完成手术,无中转开放手术。中位手术时间、中位消化道重建时间、中位术后住院时间分别为227.5(188~340)min、51(40~80)min、13(11~32)d。平均淋巴结清扫总数、平均近切缘长度分别为(27.5±3.8)枚、(5.3±1.4)cm,术后病理检查结果切缘均为阴性。术后并发症总发生率28.6%,其中吻合口并发症发生率7.1%(吻合口漏、吻合口狭窄各1例)、呼吸系统并发症发生率14.3%(胸腔积液2例、肺部感染1例、肺不张1例)、胃食管反流发生率7.1%(2例),并发症严重程度以Clavien-Dindo Ⅱ级、Ⅲa级为主。中位随访时间14个月,随访期间患者均存活,其中2例发生肝转移。结论俯卧位胸内手工吻合治疗食管受累≥4 cm的AEG在技术上是安全、可行的,能保证足够的淋巴结清扫范围和清扫数及近端切缘长度。

Obsjection To investigate the feasibility of intrathoracic hand-sewn anastomosis in prone position for adenocarcinoma of esophagogastric junction with esophageal involvement over 4 cm.Methods A descriptive case series study was conducted. The clinical data of 28 patients with AEG who underwent totally minimally invasive intrathoracic hand-sewn esophagogastric anastomosis in prone position from Mar.2019 to Dec. 2020 in the Department of gastrointestinal surgery of the First Affiliated Hospital of Zhengzhou University were collected, and analysis of short-term perioperative outcomes.Results Twenty-eight patients successfully completed the operation without conversion to open. The median operative time, esophagogastric anastomosis time and length of postoperative hospital stay were 227.5(188-340)min、51(40-80)min and 13(11-32)d, respectively. The mean total number of lymph nodes dissection and length of proximal margin were (27.5±3.8) cm and (5.3±1.4)cm, respectively, all proximal margins were negative. The overall postoperative morbidity was 28.6%, anastomotic complications rate was 7.1% (one anastomotic leakage and one anastomotic stenosis), respiratory complications rate was 14.3% (two pleural effusion, one pulmonary infection and one atelectasis), and gastroesophageal reflux rate was 7.1% (two cases). The severity of complications was mainly Clavien-Dindo Ⅱand Ⅲa. After a median follow-up of 14 months, all patients survived, and two cases occurred liver metastasis.Conclusions Intrathoracic hand-sewn anastomosis in prone position for adenocarcinoma of esophagogastric junction with esophageal involvement over 4 cm is technically safe and feasible, which can ensure sufficient extent and number of lymph node dissection and length of proximal margin.