食管胃结合部腺癌手术入路合理选择

Reasonable option of surgical approach for adenocarcinoma of the esophagogastric junction

食管胃结合部腺癌(AEG)与传统意义上的食管癌及胃癌存在较大差异。随着对其淋巴结转移规律的总结和认识,目前认为仅对于以纵隔淋巴结转移为主的SiewertI型AEG,经胸或左胸腹联合切口可作为其推荐的手术入路。对于以腹腔淋巴结转移为主的SiewertⅡ/Ⅲ型AEG,经胸入路及胸腹联合入路与开腹手术相比手术风险大、住院时间延长,且不改善病人长期存活率。由于较少合并纵隔淋巴结转移,经腹入路可作为SiewertⅡ/Ⅲ型肿瘤合理的手术选择。

Compared with traditional esophageal and gastric cancer, adcnocarcinoma of （AEG） is quite different the esophagogastric junction The transthoracic or left thoraco-abdominal incision can only be used as the recommended surgical approach for type I AEG with mediastiual lymph node metastasis. For typeⅡ/Ⅲ AEG with abdominal lymph node metastasis, the transthoracic and thoraco-abdominal approach can increase the operative risk, prolong hospitalization and can not improve long-term survival of patients compared with abdominal approach. For type Ⅱ/Ⅲ AEG with fewer mediastinal lymph node metastasis, abdominal approach is a reasonable surgical option.