经腹全胃切除术治疗食管胃结合部癌合理选择

Rational indication of total gastrectomy with abdominal approach for carcinoma of the esophagogastric junction

食管胃结合部癌的发病率在持续上升,临床以Siewert系统进行分型,食管胃结合部鳞癌与腺癌是不同的疾病。近年来的临床研究显示,对于SiewertⅡ、Ⅲ型食管胃结合部腺癌,与经胸入路比较,经腹部入路手术可以显著减少手术并发症,提高远期存活率。食管胃结合部癌的淋巴结转移主要集中在贲门左(No.1)、贲门右(No.2)、胃小弯(No.3)、胃左动脉(No.7)、肝总动脉前(No.8a)、腹腔动脉干(No.9)及脾动脉近端(No.11p)。因此,应该常规清扫上述淋巴结。除非直接侵犯,否则切脾不是全胃切除标准淋巴结清扫的适应证。

There is a recognized increase in incidence of esophagogastric junction cancer. A consensus was reached to classify into three subtypes according to the Siewert classification. Siewert Ⅱ adenocarcinoma and squamous carcinoma of esophagogastric junction existing in the same area have distinct clinicopathological characteristics.According to the results of clinical studies, left thoracoabdominal（LTA） approach did not improve survival and morbidity after LTA was worse than that after abdominal-transhithan（TH）. The incidence of lymph node metastasis is high in the right paracardial, lesser curve, left paracardial nodes and also the nodes along the left gastric artery, common hepatic artery, celiac artery and proximal splenic artery. Dissection of the above-mentioned nodes is essential for obtaining therapeutic benefit. Splenectomy is not necessary unless the tumor infiltrates spleen straightly.