Ⅱ型食管胃结合部腺癌手术径路的合理选择探讨

Reasonable selection of operative approach of type Ⅱ adenocarcinoma of the esophagogastric junction

目的:探讨Ⅱ型食管胃结合部腺癌手术的合理径路。方法:回顾性分析168例接受手术治疗的Ⅱ型AEG患者的临床资料,根据手术径路的不同分为经胸径路(Transthoracic approach,TT)组和经腹食管裂孔切开径路(abdominal transhiatal approach,TH)组,分析这2种手术径路与疗效之间的关系,判定各径路的优劣。结果:两组在切缘癌残留率、5年生存率、吻合口瘘和吻合口狭窄发生率方面,差异均无统计学意义(P>0.05),而在平均清扫淋巴结数目及减少心肺并发症发生率、手术时间、术后平均住院时间方面,经腹食管裂孔切开径路组要明显优于经胸径路组,差异有统计学意义(P<0.05)。结论:经腹食管裂孔切开径路手术兼具经腹和经胸手术的优点,手术效果良好,并发症少,是Ⅱ型AEG的首选手术径路。

Objective：To investigate the reasonable operative approach of type Ⅱ adenocarcinoma of the esophagogastric junction（AEG）.Methods：The clinical data of 168 patients of type Ⅱ AEG accepted operation were analyzed retrospectively.According to different operative approach,the patients were divided into two groups：transthoracic（TT）approach group and abdominal transhiatal（TH）approach group.The relationship between two operative approaches and curative effect were analyzed to determine a better approach.Results：No significant difference（P0.05）were observed in the residual incision margin cancer rate,5-year survival rate,anastomotic leakage rate and anastomotic stricture rate of the two surgical approaches.However,the significant difference（P0.05）was observed in the average number of harvested lymph nodes,the reduction of cardiopulmonary complication rate,the length of operation time and hospital stay after operation of two surgical approaches,TH group was better than TT group.Conclusion：Abdominal transhiatal approach is preferred operative approach of type Ⅱ AEG which has a good effectiveness of operation,fewer complications and the advantages of both transabdominal and transthoracic operations.