SiewertⅡ型和Ⅲ型食管胃结合部腺癌腹腔镜辅助近端胃切除和全胃切除疗效比较

Comparison of the efficacy between LAPG and LATG in the treatment of Siewert Ⅱ and Ⅲ AEG

目的:观察腹腔镜辅助近端胃切除(LAPG)和腹腔镜辅助全胃切除(LATG)在SiewertⅡ、Ⅲ型食管胃结合部腺癌(AEG)治疗效果。方法:分析腹腔镜手术的62例Ⅱ、Ⅲ型AEG病人的临床病理资料,经LAPG32例(LAPG组),经LATG30例(LATG组),比较2组手术操作时间、清扫淋巴结的数目、操作过程中的出血量、胃肠功能恢复时间、术后住院日及术后围手术期及出院后的并发症情况;随访了解生存及生活质量、血清癌胚抗原(CEA)情况。结果:2组术中出血量、肿瘤大小、TNM分期、近期并发症和术后12个月血清CEA水平差异均无统计学意义(P>0.05);LAPG组平均清扫的淋巴结数目为(19.7±4.6)枚,较LATG组(22.9±6.7)枚少(P<0.01),手术时间长于LAPG组(P<0.01),术后反流性食管炎发生率(40.0%)多于LAPG组(3.0%)(P<0.01)。结论:LAPG和LATG治疗SiewertⅡ和Ⅲ型AEG安全性相当,LATG淋巴结清扫数目更多,远期并发症少。对于进展期的AGE建议行LATG。

Objective:To compare the clinical efficacy between laparoscopic-assisted total gastrectomy(LATG) and laparoscopic-assisted proximal gastrectomy(LAPG) in the treatment of Siewert Ⅱ and Ⅲ esophagogastric adenocarcinoma(AEG). Methods:The clinical data of 62 patients with type Ⅱ and type Ⅲ AEG were retrospectively analyzed.Thirty-two cases treated with LAPG and 30 cases treated with LATG were divided into the LAPG group and LATG group,respectively.The operation time,number of lymph nodes dissected,blood loss during operation,recovery time of gastrointestinal function,postoperative hospital stay,perioperative and postoperative complications were compared between two groups.The survival,quality of life and CEA situation in two groups were recorded. Results:The differences of the intraoperative bleeding volume,TNM staging,recent complications and level of serum CEA after 12 months of operation between two groups were not statistically significant( P >0.05).The number of lymph nodes in LATG group[(22.9±6.7)] was more than that in LAPG group[(19.7±4.6)]( P <0.01),the operation time in LATG group was significant longer than that in LAPG group( P <0.01),and the incidence rate of reflux esophagitis in LAPG group(40.0%) was more than that in LAPG group(3%)( P <0.05). Conclusions:The LAPG and LATG in treating Siewert type II and III AEG are safety.The lymph node dissection of LATG is more,and the long-term complications of LATG is fewer.The progressive phase AGE should be treated with LATG.