不同手术径路治疗SiewertⅡ型食管胃结合部腺癌的疗效评价

Effects of different surgical approaches on Siewert Ⅱ adenocarcinoma of esophagogastric junction

目的探讨不同手术径路治疗进展期SiewertⅡ型食管胃结合部腺癌（食管浸润≤3cm）的优缺点及疗效。方法对251例SiewertⅡ型食管胃结合部腺癌患者施行D2或D2^＋的全胃切除术，其中经腹部正中切口组（the transabdominal approach，TA组）128例，经左胸腹联合切口组（the left thoracoabdominal approach，LTA组）123例，对两组的手术时间、术中出血量、远段食管切除长度、上切缘癌残留率、平均淋巴结清扫数目、围术期并发症发生率、病死率以及术后3、5年总体生存率进行对比分析。结果TA组和LTA组的术后3、5年总体生存率分别为62．5％、39．0％和54．9％、31．9％，两组相比差异均无统计学意义（P〉0．05）。LTA组的远段食管切除长度较TA组稍长（5．6±1．1）cm比（5．4±1．1）cm，但两组手术的切缘癌残留率为1．6％（LTA组）比3．1％（TA组），差异均无统计学意义（均P〉0．05）。TA组手术平均淋巴结清扫数目（23．4±8．7）枚，与LTA组的（23．7±8．4）枚比较差异无统计学意义（P〉0．05）。TA组在手术时间（227±24）min、术中出血量（270±78）ml及围术期并发症发生率（13．3％）和病死率（1．6％）方面均明显优于LTA组[（261±32）min、（342±59）ml，26．8％和6．5％]，差异均具有统计学意义（均P〈0．05）。结论对SiewertⅡ型食管胃结合部腺癌（食管浸润≤3cm）患者，经腹部正中切口行全胃切除术（D2或D2^＋淋巴结切除术）可达到良好的根治目的，且围术期并发症的发生率和病死率均较低。

Objective To compare the-effects of different surgical approaches on Siewert Ⅱ （esophageal invasion ≤3 cm） adenocarcinoma of esophagogastric junction. Methods This retrospective study included 251 cases of Siewert II adenocarcinoma of esophagogastric junction undergoing D2 or D2 ^＋ total gastrectomy by transabdominal approach（ TA group, 128 cases） or left thoracoabdominal approach（ LTA group, 123 cases）. Operation time, blood loss, extent of esophageal resection, number of lymph nodes dissected, morbidity, mortality and the survival rate were a analyzed between the two groups. Results The 3,5-year overall survival rates were 62. 5%, 39. 0% （TA group） and 54.9%, 31.9% （LTA group）, respectively （ P 〉 0. 05 ）. Length of esophageal resection in the LTA group were slightly longer than that in the TA group （5.6± 1.1 ） cm vs. （5.4 ±1.1 ） cm （ P 〈 0. 05 ）, the positive surgical margin between two groups were not statistically different [ 1.6% （ LTA group） vs. 3.1% （ TA group）, （ P 〉 0. 05 ） ]. The mean number of removed lymph node were not significantly different between two groups [ 23.4 ± 8.7 （ TA group ） vs. 23.7 ± 8. 4 （ LTA group） ], （ P 〉 0. 05 ）. The operation time （ 227 ± 24 ） min, blood loss （ 270 ± 78）ml, and perioperative morbidity（ 13.3% ） and mortality（ 1.6% ） in TA group was significantly better than the LTA group [（261 ±32） min, （342±59）ml, 26.8% , 6.5%] （P〈0.05）. Conclusions For Siewert 11 adenocarcinoma at esophagogastric junction （esophageal invasion ≤3 cm） ,total gastrectomy with D2 or D2 ^＋ lymph node dissection through the transabdominal approach could achieve curative purposes, with a low morbidity and mortality rate.