采用食管管型胃侧侧吻合术的胸腹腔镜联合食管胃结合部腺癌根治术

Thoracoscopic and laparoscopic radical resection for adenocareinoma of the esophagogastric junction with side-to-side tubular gastroesophagostomy

目的：探讨采用食管管型胃侧侧吻合术的胸腹腔镜联合食管胃结合部腺癌（AEG）根治术的临床疗效。方法：采用回顾性描述性研究方法。收集2017年11月至2018年6月厦门大学附属第一医院收治的4例AEG患者的临床病理资料。行采用食管管型胃侧侧吻合术的胸腹腔镜联合AEG根治术。术后常规行SOX方案辅助化疗，疗程为6个周期。观察指标：（1）手术及术后恢复情况。（2）术后病理学检查情况。（3）随访和生存情况。采用门诊和电话方式进行随访，了解患者术后行辅助化疗情况和生存情况。随访时间截至2018年9月。结果：（1）手术及术后恢复情况：4例患者均顺利完成采用食管管型胃侧侧吻合术的胸腹腔镜联合AEG根治术，无中转开胸、开腹和围术期死亡患者。病例1、2、3、4手术时间分别为420、400、320、300 min，术中出血量分别为100、100、150、100 mL，术后首次进食流质食物时间分别为9、8、8、8 d，术后引流管拔除时间分别为11、10、10、10 d。病例1术后发生轻度肺炎和呃逆，病例2术后发生轻度肺炎，予对症处理后好转；病例3和4术后未发生并发症。4例患者术后吻合口均通畅，排空良好。病例1、2、3、4术后住院时间分别为12、11、11、11 d。（2）术后病理学检查情况：4例患者手术切缘均为阴性。病例1、2、3、4淋巴结清扫总数分别为32、31、17、23枚，阳性淋巴结数目分别为0、4、2、6枚，肿瘤直径分别为3.5、5.0、5.0、4.0 cm，肿瘤分化程度和病理学类型均为中分化腺癌，Siewert 分型分别为Ⅱ、Ⅰ、Ⅱ、Ⅰ型，肿瘤浸润深度分别为浆膜下、全层、浆膜下、全层，肿瘤病理学分期分别为ⅡA、ⅢB、ⅡB、ⅢA期。（3）随访和生存情况：4例患者均获得术后随访，随访时间为3～10个月，中位随访时间为5个月。随访期间，4例患者均行辅助化疗，无瘤生存。结论：采用食管管型胃侧侧吻合术的胸腹腔镜联合AEG根治术安全可行。

Objective：To investigate the clinical efficacy of thoracoscopic and laparoscopic radical resection for adenocarcinoma of the esophagogastric junction （AEG）with side-to-side tubular gastroesophagostomy. Methods：The retrospective and descriptive study was conducted. The clinicopathological data of 4 patients with AEG who were admitted to the First Affiliated Hospital of Xiamen University between November 2017 and June 2018 were collected. All the patients underwent thoracoscopic and laparoscopic radical resection for AEG using side-to-side tubular gastroesophagostomy and received 6 cycles of postoperative adjuvant chemotherapy with SOX regimen. Observation indicators： （1） surgical and postoperative recovery situations; （2） postoperative pathological examination; （3） follow-up and survival situations. The follow-up using outpatient examination and telephone interview was performed to detect postoperative adjuvant therapy situations and survival of patients up to Semptember 2018. Results：（1）Surgical and postoperative recovery situations： 4 patients successfully underwent thoracoscopic and laparoscopic radical resection for AEG using side-to-side tubular gastroesophagostomy, without conversion to thoracotomy, open surgery or perioperative death. Operation time, volume of intraoperative blood loss, time for postoperative fluid diet intake and postoperative drainagetube removal time of case 1, 2, 3, 4 were respectively 420 minutes, 400 minutes, 320 minutes, 300 minutes and 100 mL, 100 mL, 150 mL, 100 mL and 9 days, 8 days, 8 days, 8 days and 11 days, 10 days, 10 days, 10 days. Case 1 with mild pneumonia and hiccup and case 2 with mild pneumonia were improved by symptomatic treatment, case 3 and 4 didn′t have complication. All the patients had postoperative patent anastomosis. Duration of postoperative hospital stay of case 1, 2, 3, 4 were respectively 12 days, 11 days, 11 days, 11 days. （2） Postoperative pathological examination： all the 4 patients had negative surgical margin. Number of lymph node dissected, number of positive lymph node, tumor diameter, Siewert type, depth of tumor infiltration, tumor histopathologic stage of case 1, 2, 3, 4 were respectively 32, 31, 17, 23 and 0, 4, 2, 6 and 3.5 cm, 5.0 cm, 5.0 cm, 4.0 cm and typeⅡ,Ⅰ,Ⅱ,Ⅰand subserosa, entire wall of the esophagogastric junction, subserosa, entire wall of the esophagogastric junction and ⅡA staging, ⅢB staging, ⅡB staging, ⅢA staging. Degree of tumor differentiation and pathological type were moderately differentiated adenocarcinoma in the 4 patients. （3） follow-up and survival situations： 4 patients were followed up for 3-10 months, with a median time of 5 months. During the follow-up, 4 patients underwent chemotherapy and achieved diseasefree survival. Conclusion：Thoracoscopic and laparoscopic radical resection for AEG using side-to-side tubular gastroesophagostomy is safe and feasible.