食管胃交界部腺癌CT分型与手术入路选择

CT typing and surgical approach for adenocarcinoma of the esophagogastric junction

目的探讨依据术前增强CT对食管胃交界部腺癌进行临床分型并指导手术入路选择的可行性、安全性及疗效。方法回顾性分析2012年5月至2016年6月河南省肿瘤医院普外科连续517例食管胃交界部癌按照术前增强CT表现进行三层四分法分型并统计各型手术患者的临床病理资料。结果本组517例患者均顺利完成手术，其中Ⅰ型152例（131例完全经腹手术，21例经腹切开膈肌进胸手术），Ⅱ型239例（177例完全经腹手术，62例经腹切开膈肌进胸手术），Ⅲ/Ⅳ型选择胸腹联合手术126例。手术时间为（102±17）min，术中出血量为（136±18）ml，术后发生显性吻合口瘘16例，胰漏5例，肠梗阻7例，吻合口狭窄3例，胸腹腔感12例，所有并发症均经保守治疗后痊愈。食管切缘距肿瘤平均（5.1±0.6）cm，2例食管切缘残端癌残留，平均出院时间（8.9±1.6）d。结论应用术前增强CT进行食管胃交界部腺癌分型并选择手术入路，可以兼顾手术安全性的同时最大限度保障食管下端的安全切缘，同时减少不必要的开胸手术，有望成为食管胃交界部癌手术的一种新的分型方式。

Objective To investigate the feasibility, safety and efficacy of preoperative CT in the classification of adenocarcinoma of the esophagogastric junction.Methods A total of 517 consecutive patients from May 2012 to June 2016 with esophagogastric junction carcinoma in the department of general surgery of Henan Cancer Hospital was retrospectively analyzed, according to the clinical pathological data of three type four layer method and statistics of various types of surgery in patients with preoperative enhanced CT.Results 517 patients were successfully received surgery, including 152 cases of type Ⅰ（131 cases of complete abdominal surgery, 21 cases of abdominal incision diaphragm in thoracic surgery）, 239 cases of type Ⅱ （177 cases of complete abdominal surgery, 62 cases of abdominal incision diaphragm in thoracic surgery）, Ⅲ/Ⅳ type choice of chest abdominal surgery in 126 cases. The operation time was （102±17） min, the amount of hemorrhage was （136±18） ml, the dominant anastomotic fistula happened in 16 cases, 5 cases of pancreatic fistula, 7 cases of intestinal obstruction, anastomotic stenosis in 3 cases, thoracic and abdominal sensation in 12 cases, all the complications were cured by conservative treatment. The average value of esophageal resection margin was（5.1±0.6）cm, 2 cases with positive residual tumor margin and average length of stay was （8.9±1.6）d.Conclusion Using preoperative enhanced CT in the adenocarcinoma of the esophagogastric junction to choose surgical approach can ensure the safety margin. What′s more, unnecessary thoracotomy is reduced which is expected to be a new classification method for the operation of esophagogastric junction cancer.