经上腹正中切口入路治疗食管胃结合部腺癌的临床疗效

Different surgical approaches for adenocarcinoma of the esophagogastric junction

目的:探讨经上腹正中切口入路治疗食管胃结合部腺癌临床疗效.方法:将我院收治的150例食管胃结合部腺癌患者随机均分为实验组和对照组,实验组患者经上腹正中切口入路;对照组患者经左侧第7助间后外侧切口入路.观察两组患者手术情况、术后病理及术后并发症发生情况.结果:实验组平均手术时间(187.42 min±48.47 min vs 225.79 min±83.98 min)、术中平均出血量(128.09 mL±48.95 mL vs 208.01mL±70.12 mL)及食管周围淋巴结个数(0.18±0.67 vs 0.18±0.67)均明显低于对照组,差异具有显著性(P<0.05);实验组清扫淋巴结总数(12.71±7.19 vs 8.20±5.31)、小弯侧淋巴结个数(6.51±3.09 vs 1.72±1.83)及食管旁淋巴结清扫数(12 vs 44)均明显低于对照组,小弯侧淋巴结清扫数(330 vs 102)明显高于对照组,差异具有显著性(P<0.05);两组患者手术切口阳性率(14.66%vs 10.66%)比较差异无统计学意义(P>0.05);两组患者小弯侧阳性率(75.76%vs 11.11%,66.04%vs 22.73%)均明显高于食管旁阳性率,差异具有显著性(P<0.05);两组患者术后均无1例发生吻合口瘘,实验组并发症总发生率(2.67%vs 14.67%)明显低于对照组,差异具有显著性(P<0.05).结论:经腹入路手术对胃周淋巴结清扫更为彻底,全胃切除术对小弯侧淋巴结清扫更为彻底,在进行手术路径选择时需要结合患者病灶实际情况以及患者体质合理选择,提高预后效果.

AIM： To investigate the therapeutic effects of dif- ferent surgical approaches for adenocarcinoma of the esophagogastric junction （AEG）. METHODS： One hundred and fifty AEG pa- tients were randomly divided into either an experimental group or a control group. The experimental group underwent surgery via a transabdominal approach, while the control group was treated via a transthoracic approach. The operation situation, postoperative pathol- ogy and complications were compared between the two groups. RESULTS： There were significant differences in mean operative time （187.42 min ± 48.47 min vs 225.79 min ±83.98 min）, mean blood loss （128.09 mL ± 48.95 mL vs 208.01 mL ± 70.12 mL）, num- ber of paraesophageal lymph nodes （0.18 ± 0.67 vs 0.18 ± 0.67）, number of cleared lymph nodes /12.71 ± 7.19 vs 8.20 ± 5.31）, number of lymph nodes in the lesser curvature （6.51 ± 3.09 vs 1.72 ± 1.83）, number of paraesophageal lymph nodes （12 vs 44）, and number of cleared lymph nodes in the lesser curvature （330 vs 102） between the experimental group and control group （All I 〈 0.05）. No significant difference was noted in the rate of positive margins （14.66% vs 10.66%, P 〉 0.05） between the two groups. The rate of posi- tive curvature lymph nodes in the lesser cur- vature was significantly higher than that in the periesophagus in both groups （75.76% vs 11.11%, 66.04% vs 22.73%）. No anastomotic fistula oc- curred in either group, although the complica- tion rate was lower in the experimental group than in the control group （2.67% vs 14.67%, P 〈 0.05）, CONCLUSION： Transabdominal surgery can clear more lymph nodes than transthoracic sur- gery. Total gastrectomy does better in the clear- ance of perigastric lymph nodes, especially those in the lesser curvature.