食管胃结合部腺癌

Adenocarcinoma of esophago-gastric junction

近年来食管胃结合部癌肿发病率明显上升，欧美国家年增长率达5％～10％，逐渐引起人们的重视。1987年德国学者Siewert提出“食管胃结合部腺癌”的概念，定义为食管胃结合部上下5cm区域内的腺癌，分为3型。亚洲以Ⅱ型和Ⅲ型多见，5年生存率没有差别；西方国家则3种类型比例相当。其中Ⅰ型预后最好，Ⅲ型最差。目前认为这是一种不同于食管癌和胃癌的特殊类型癌肿，其手术径路、术式和淋巴结清扫范围均未完全达成共识，也还缺少独立的TNM分期系统。本文就食管胃结合部腺癌的诊疗现状作一综述。

The incidence of gastroesophageal junction cancers is rapidly increasing, the Year＇ s upwards rate being more than 5%- 10%. Siewert in 1987 proposed a definition for adenocarcinoma of the esophagogastrie junction （AEG）, as a adenocarcinoma within 5 cm of the gastroesophageal junction （GEJ）, and divided AEG in to three types. The majority of patients with AEG in Asian countries have type Ⅱ and Ⅲ cancers, and no obvious differences have been reported in 5-year survival rates between patients with different types of AEG. In contrast, in western countries, the distribution of each type of AEG is nearly equal,patients with AEG type Ⅰ cancer have the best prognosis, whereas the overall survival of patients with type Ⅲ cancer is the worst. Now people presume that the AEG is a special type of carcinoma which is not same as carcinoma of esophagus and stomach. The surgical routes and operative methods and the extent of lymph node dissection of AEG are still not completely clear, and AEG lacks also a independent TNM system for itself. We will gummarize the actuality of diagnosis and therapy of AEG.