全腹腔镜下经胸腔入路治疗Siewert Ⅱ型食管胃结合部腺癌可行性研究

Feasibility study of totally laparoscopic transthoracic approach to treat Siewert Ⅱ adenocarcinoma of the esophagogastric junction

目的探讨全腹腔镜下经胸腔入路治疗Siewert Ⅱ型食管胃结合部腺癌的可行性。方法回顾性分析2017年3-6月吉林大学第二医院胃肠外科行全腹腔镜下经胸腔入路行D2淋巴结清扫和消化道重建的4例Siewert Ⅱ型食管胃结合部腺癌病人的临床资料。均行近端胃切除,并行食管-管状胃消化道重建。结果 4例病人均顺利完成手术,无中转开腹手术。肿物直径为3~5 cm,侵及食管1~3 cm,手术时间为230~370 min,消化道重建时间为40~50 min,术中出血20~90 m L,排气时间为3~4 d,住院时间为8~14 d。无死亡病例,无明显术后并发症发生。随访截至2017-09-01,病人无明显食管反流、进食困难等并发症发生。结论对Siewert Ⅱ型食管胃结合部腺癌行全腹腔镜下经胸腔入路淋巴结清扫和食管-管状胃消化道重建初步疗效观察显示安全可行,值得进一步探索和研究。

Objective To investigate the feasibility of totally laparoscopic transthoracic approach to treat Siewert Ⅱ adenocarcinoma of the esophagogastric junction patients. Methods Clinical and follow-up data of four patients who underwent totally laparoscopic transthoracic approach surgery（proximal gastrectomy, D2 lymph nodes dissection and esophageal-tubular reconstruction） in our department from March to June 2017 were analyzed retrospectively. Results Four patients were successfully completed the operation, no conversion. The size of tumor was 3-5 cm, the length of esophageal invasion was 1-3 cm. The operation time was 230-370 min, the digestive tract reconstruction time was 40-50 min, the volume of intraoperative bleeding was 20-90 mL, the first flatus time was 3-4 d and the hospital stay was 8-14 d. The patients were followed up till 01-09-2017, no obvious esophageal reflux and eating difficulties happened. Conclusion Totally laparoscopic transthoracic approach to treat Siewert Ⅱ adenocarcinoma of the esophagogastric junction patients is safe and feasible.