食管胃结合部腺癌的外科治疗

Surgical treatment of adenocarcinoma of the esophagogas-tric junction

食管胃结合部癌的发病率呈持续上升的趋势，尤其是在西方国家。外科手术切除仍然是治疗食管胃结合部癌的基石。由于肿瘤位于食管和胃的结合部，所以对其定义、分型、分期和手术方式都还存在一些争议。Siewert分型是目前认可程度最高的分型方法。对于进展期SiewertⅠ型食管胃结合部癌，其生物学特性和外科治疗方案更接近于食管癌；对于进展期SiewertⅡ、Ⅲ型食管胃结合部癌，外科治疗方案更接近于胃癌。而对于早期食管胃结合部癌，可以采用内镜切除或者缩小手术。

The incidence of adenocarcinoma of the esophagogastric junction （AEG） is dramatically increasing world- wide, especially in western countries. Surgical resection remains the mainstay of potentially curative therapy for esophagogastric junction tumors. AEG has been a source of controversy in regard to the definition, classification, staging and surgical manage- ment. The definition of AEG was addressed with the develop- ment of the three-tiered Siewert＇s classification scheme. Siewert type I AEG should be treated surgically as esophageal cancer, and right thoracic approach with a mediastinal lymph node dissection may be recommended, while Siewert type 11/]II AEG should be regarded as true gastric cancer, and a transhiatal extended gastrectomy is the preferable approach for Siewert type ll/m AEG. Limited resections or endoscopic resection for earlier stage tumors have also been evaluated.