腹腔镜经膈肌裂孔近侧胃切除治疗食管胃交界腺癌的手术配合

Operative cooperation of laparoscopic transhiatal proximal gastrectomy for the esophagogastric junction adenocarcinoma

目的总结腹腔镜经膈肌裂孔近侧胃切除治疗食管胃交界腺癌的手术安全性及配合经验。方法对98例行腹腔镜经膈肌裂孔近侧胃切除治疗食管胃交界腺癌手术配合要点进行分析和总结。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）。手术时间为（224．1±33．7）cm；术中出血量为（69．4±26．1）ml；切除食管长度为（4．0±0．6）cm；术后病检切缘均无癌残留；平均获取淋巴结（16．4±5．7）枚／例。术中损伤胸膜14例，损伤脾脏3例，无围手术期死亡。随访时间3～30个月，随访期间死亡5例。结论充分的术前评估准备及手术团队人员密切配合是前提，腹腔镜经膈肌裂阿司匹孔近侧胃切除治疗食管胃交界腺癌安全可行，近期临床效果较好。

Objective To summarize the safety and experience of operative cooperation of the laparoscopic transhiatal proximal gastrectomy therapy for esophagogastric junction adenocarcinoma. Methods Totals of 98 eases with esophagogastric junction adenocarcinoma underwent the treatment of laparoscopic transhiatal proximal gastrectomy were analyzed and summarized. Results Totals of 96 patients underwent laparoscopic transhiatal proximal gastrectomy successfully and 2 converted to open operation （one patient combined splenectomy and the other combined spleneetomy 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 no cancer cells were found in the incision edge. The number of lymph nodes removed was （16.4 ± 5.7）. Among 96 patients, pleural laceration occurred 14 cases and spleen injury occurred 3 cases, no postoperaive mortalities happened. After follow-up from 3 month to 30 month, 5 patients died. Conclusions Fully preoperative assessment and closely cooperation of operation team are important for the laparoscopic transhiatal proximal gastrectomy therapy for esophagogastric junction adenocarcinoma, which have a good short-term clinical effects.