不同术式对食管胃交界部癌的临床疗效探析

Clinical effect of different surgical strategies for patients with adenocarcinoma of esophagogastric junction

目的探讨腔镜手术和传统手术两种术式对食管胃交界部癌的临床疗效。方法回顾分析我院过去5年AEG患者手术及随访情况,比较不同术式对食管胃交界部癌的临床疗效和预后。结果腔镜组术中出血量(122.5±34.6)ml,肛门排气时间(2.6±1.1)d,下床活动时间(4.1±1.3)d,住院时间(10.1±1.5)d;传统手术组术中出血量(164.2±28.9)ml,肛门排气时间(4.9±2.6)d,住院时间(15.2±5.3)d,两组间差异均有统计学意义(均P<0.05);腔镜组清扫淋巴结(28±3)枚,传统手术组清扫(29±4)枚,两组比较差异无统计学意义(P>0.05);腔镜组术中发现上纵隔淋巴结转移率1.59%,中下纵膈淋巴结转移率28.57%,腹腔淋巴结转移率38.10%,与传统手术比较,差异均有统计学意义(均P<0.05);腔镜组并发症发生率22.22%,传统手术组32.17%,两组差异亦有统计学意义(P<0.05);术后随访,腔镜组复发转移率4.76%,传统手术组4.35%,两组差异无统计学意义(χ2=2.142,P=0.095)。结论腔镜手术术后康复快,术后并发症发生率低,对淋巴结转移的发现能力与传统手术各有优势,临床可酌情推广应用。

Objective To observe the clinical effect of endoscopic and traditional surgery for patients with adenocarcinoma of esophagogastric junction（AEG）. Methods The conditions of surgery and follow-up in patients with AEG over the past five years were retrospectively analyzed, and the clinical effect and prognosis of difference surgical strategies for patients with AEG were compared. Results Intraoperatve blood soss, anus exhaust time, ambulation time and length of stay of endoscopic group respectively were 122.5±34.6 ml, 2.6±1. ld, 4.1±1.3d and 10.1±1.5d, which of traditional group were 164.2±4-28.9ml, 4.9±2.6 d and 15.2Э5.3 d. The differences between two groups was statistically significant （P〈0.05）. Cleaning lymph node of endoscopic group and traditional group were 28±3 and 29 ±4 （P〉0.05）. Transport rate of mediastinal lymph node of endoscopic group was 1.59%;the middle and lower mediastinal lymph node was 28.57%; celiac lymph nodes was 38.10%. The differences was statistically significant （P〈0.05）. Incidencd of complication of endoscopic group and traditional group were 22.22% and 32.17% （P〈0.05）. Transport rate of recurrence of endoscopic group and traditional group were 4. 76% and 4.35% （x^2 =2. 142,P=0. 095）. Conclusion Endoscopy surgery was fast, and complication probability of postoperative is low, but the ability of discovery of lymph node has advantages compared with traditional operation.