腹腔镜经膈肌裂孔近端胃切除治疗食管胃交界部腺癌98例

Laparoscopic transhiatal proximal gastrectomy for adenocarcinoma of the esophagogastric junction： report of 98 cases

目的探讨腹腔镜经膈肌裂孔近端胃切除治疗食管胃交界部腺癌（AEG）的安全性及近期临床效果。方法回顾2008年8月至2011年5月接受腹腔镜经膈肌裂孔近端胃切除术治疗的98例AEG患者的临床资料，分析手术时间、术中出血情况、食管切除长度、淋巴结清扫情况及术后近期并发症。结果腹腔镜下完成近侧胃切除术96例，中转开腹2例（联合脾切除术1例，联合脾脏、胰尾切除术1例）。手术时间（224．1±33．7）min；术中出血（69．4±26．1）ml；切除食管长度（4．0±0．6）cm；术后病检切缘均无癌残留；获取淋巴结（16．4±5．7）枚／例。术中损伤胸膜14例，损伤脾脏3例；术后吻合口瘘1例，无吻合口狭窄、术后出血、切口（包括穿刺孔）感染及围手术期死亡病例。随访时间3～30个月，术后1个月和3个月反流性疾病问卷表评分分别为（9．9±4．4）和（9．3±4．3），无切口（包括穿刺孔）癌种植，随访期间死亡5例。结论腹腔镜经膈肌裂孔近侧胃切除治疗AEG安全可行．近期临床效果较好。

Objective To explore the safety and short-term efficacy of laparoscopic transhiatal proximal gastrectomy in patients with adenocarcinoma of the esophagogastric junction. Methods From Aug 2008 to May 2011, 98 patients with adenocarcinoma of the esophagogastric junction underwent laparoscopic transhiatal proximal gastrectomy. Clinical data were analyzed retrospectively including operative time, estimated bleeding, length of resection, lymph node dissection, and short-term postoperative complications. Results Ninety-six patients underwent laparoscopic transhiatal proximal gastrectomy successfully and 2 were converted to open operation （one for combined splenectomy and the other combined splenectomy and resection of the tail of the pancreas）. The mean operative time was （224.1±33.7） min and the mean blood loss was （69.4±26.1） ml. The mean length of esophageal resection was （4.0±0.6） cm and the resection margin was negative. The number of lymph node removed was 16.4±5.7. Pleural laceration occurred in 14 cases and spleen injury occurred in 3 case during operation. There was one anastomotic leakage. There were no postoperative mortalities, bleeding, anastomotic stenosis and wound infection. After follow-up ranging from 3 to 30 months, the value of reflux diagnostic questionnaire （RDQ） was 9.9±4.4 at 1 month and 9.3±4.3 at 3 months postoperatively. No incision metastasis was found and 5 patients died. Conclusion Laparoscopic transhiatal proximal gastrectomy is safe for patients with adenocarcinoma of the esophagogastric junction and the short-term clinical outcomes are favorable.