经腹手术治疗Siewert Ⅱ、Ⅲ型食管胃结合部腺癌123例临床分析

Laparotomy for Siewert Ⅱ and Ⅲ adenocarcinoma at esophagogastric junction： a clinical study of 123 cases

目的探讨经腹手术治疗食管胃结合部腺癌（AEG）的临床价值。方法回顾性分析2004年6月至2007年6月间施行经腹手术123例AEG患者的临床资料。结果所有患者均顺利手术，平均手术时间（224．6±21．1）min，术中平均失血量（145．1±25．2）ml，术后病理显示切缘均为阴性，按照Siewert分型，Ⅱ型72例，Ⅲ型51例。术后出现吻合口漏、呕吐、反酸及肺部感染等并发症，均予以非手术治疗后治愈。随访12个月内无肿瘤复发或转移，5年生存率为29．4%。结论对SiewertⅡ、Ⅲ型AEG患者，经腹入路是有效的手术方式；术前准确的分型、分期，可得到更好的治疗效果。

Objective To explore the clinical value of laparotomy for Siewert Ⅱ and Ⅲ adeno- carcinoma at esophagogastric junction （AEG）. Methods The clinical data of 123 cases of AEG undergoing laparotomy from June 2004 to June 2007 were analyzed retrospectively. Results All the patients underwent the operation successfully. The mean operation time was （224. 6 ± 21.1） rain,and mean intraoperative blood loss was （145. 1 ± 25.2） mL. The average time to flatus was （2. 7± 1.9） days. All the resection margins were negative. According to Siewert typing, there were 72 cases of type Ⅱ and 51 cases of type Ⅲ. Postoperative complications included anastomotic leakage, vomiting, sour regurgitation and pulmonary infection, which were all cured by conservative treatment. There was no tumor recurrence or distant metastasis after 12 months of follow-up. The 5-year survival rate was 29. 4%. Conclusion For Siewert Ⅱ and Ⅲ AEG patients, transabdominal resection is reasonable and effective, and patients may benefit by accurate clinical typing and phasing before operation.