腹腔镜胃食管结合部癌切除术中淋巴结清扫的评价

Laparoscopic gastroesophageal junction cancer lymphadenectomy

目的探讨胃食管结合部癌腹腔镜淋巴结清扫的效果及安全性。方法回顾性分析2011年1月至2012年12月重庆医科大学附属第一医院胃肠外科行胃食管结合部癌切除手术72例患者的临床资料，其中开腹组26例，腹腔镜组46例。结果开腹胃食管结合部癌根治术组清扫淋巴结（23±7）个，腹腔镜近端胃癌根治术组清扫淋巴结（24±8）个，两组相比差异无统计学意义（t=0．532，P=0．596）；开腹组清扫阳性淋巴结（0．92±0．29）个，腹腔镜组为（0．89±0．23）个，两组相比差异无统计学意义（t=0．508，P=0．613）；开腹组中有11例患者淋巴结病理为阳性，而腹腔镜组为16例，两组相比差异无统计学意义（x^2=0．401，P=0．526）；开腹组食管切除长度为（2．0±1．0）cm，腹腔镜组为（3．0±0．8）cm，两组相比差异有统计学意义（t=0．471，P〈0．001）；26例开腹组患者中有5例（19％）患者术中病理切缘阳性，46例腹腔镜组有6例（13％）患者术中切缘阳性，两组相比差异无统计学意义（x^2=0．491，P=0．483）；开腹组中有7例患者，腹腔镜组有3例患者行胸腹联合肿瘤切除，两组比较差异有统计学意义（r=5．781，P=0．016）；腹腔镜组清扫的脾门淋巴结（第10组＋第11组）数量比开腹组多[（3．9±2．2）个比（2．6±1．7）个，t=0．260，P=0．011]，但两组清扫脾门淋巴结的阳性数量[（0．55±0．31）个比（0．70±0．36）个，t=1．782，P=0．079]和阳性比例（7／26比13／46，x^2=0．015，P=0．903）相比差异均无统计学意义；腹腔镜胃癌根治术加脾门淋巴结清扫术手术时间比开腹组短[（192±126）min比（271±152）min，t=0．237，P=0．021]，手术出血量少[（104±43）ml比（163±68）ml，t=0．451，P〈0．01]。两组严重手术并发症相比差异无统计学意义。结论腹腔镜胃食管结合部癌手术在脾门淋巴结清扫方面比开腹手术具备优势，其清扫数量多于开腹手术。腹腔镜食管切除距离较长，能够减少胸腹联合手术的发生。腹腔镜胃食管结合部癌根治术比开腹手术时间缩短，出血量也较少，而且是安全的。

Objective To analyze laparoscopic lymphadenectomy and the safety of gastrectomy for gastroesophageal junction cancer. Methods From Jan 2011 to Dec 2012 72 gastroesophageal junction cancer patients were enrolled, including 46 patients in laparoscopic group, and 26 in open surgery group. Results There was no significant difference in the numgbers of lymph node dissection between the two groups and nor difference in the number of positive lymph node dissection. Esophagus resection length in open group was （ 2. 0 ±1.0 ） cm, while that was （ 3.0 ± 0. 8 ） cm in laparoscopic group （ t = 0. 471, P 〈 0. 001 ）. 5 （19%）patients in open group had positive margins compared to six in laparoscopic group （ 13% ）,x^2 = 0. 491, P = 0. 483. 7 patients in the open group underwent thoracoabdominal resection, while in laparoseopic group 3 patients did, x^2 = 5. 781, P = 0. 016. Laparoscopie splenic hilar lymphnodes dissection harvested more lymph nodes （t = 0.260, P = 0.011 ）. Laparoscopic gastreetomy used less operation time （ t = 0. 237, P = 0. 021 ） experinced less blood loss （ t = 0. 451, P 〈 0.01 ） than open group. There was no difference in major complications between the two groups. Conclusions Laparoscopic splenic hilar lymphnodes dissection in gastroesophageal junction cancer surgery is superior to open surgery, with more lymph nodes harvested, longer esophageal cutting distances, lower incidence of thoracoabdominal surgery, shorter operation time, and less blood loss.