全腹腔镜下经腹经膈肌胸腹联合治疗Ⅱ型食管胃结合部腺癌的临床体会

Clinical experience of laparoscopic radical gastrectomy for Siewert type Ⅱ gastroesophageal junction adenocarcinoma via the transabdominal-hiatal approach

目的:探讨完全腹腔镜下经腹经膈肌胸腹联合治疗Ⅱ型食管胃结合部腺癌的安全性及近期疗效。方法:将2015年1月1日至2018年6月1日收治的Ⅱ型食管胃结合部腺癌患者作为研究对象,均在全腹腔镜下经腹经膈肌胸腹联合途径行全胃切除+π型食管空肠侧侧吻合术,观察淋巴结清扫时间、消化道重建时间、术中失血量、术后住院时间、淋巴结清扫总数、第110组淋巴结数量、术后并发症、术后病理、随防情况等。结果:淋巴结清扫时间平均(105.91±2.92)min,消化道重建时间(70.00±3.13)min,术中失血量平均(80±20)mL,术后平均住院(9±2)d,淋巴结清扫总数(35.5±5.5)枚/例,第110组淋巴结数量(3.5±1.5)枚/例,术中无并发症发生,术后出现吻合口漏2例,经保守治疗后出院。术后病理均示切缘无肿瘤残留。术后随访≥6个月,无吻合口出血、狭窄、复发等并发症发生。结论:Ⅱ型食管胃结合部腺癌在全腹腔镜下经腹经膈肌胸腹联合行胃癌根治术安全性高,疗效确切。

Objective:To evaluate the safety and short-term efficacy of the total laparoscopic radical gastrectomy for Siewert typeⅡgastroesophageal junction adenocarcinoma via the transabdominal-hiatal approach.Methods:From Jan.2015 to Jun.2018,the patients with Siewert typeⅡgastroesophageal junction adenocarcinoma were treated with the total laparoscopic radical gastrectomy withπ-shaped esophagojejunal anastomosis via the transabdominal-hiatal approach,the lymph node dissection time,time of digestive tract reconstruction,intraoperative blood loss,postoperative hospital stay,the total number of lymph node dissection,number of lymph nodes in group 110,postoperative complications,postoperative pathology,and the follow-up survey were observed.Results:The average time of lymph nodes dissection was(105.91±2.92)min,the average time of digestive tract anastomotic was(70.00±3.13)min,the average blood loss during operation was(80±20)mL,the mean hospital stay was(9±2)d,the total number of lymph nodes dissection was(35.5±5.5)/case,the number of lymph nodes in the 110th group was(3.5±1.5)/case.There was no intraoperative complications or residual tumor in postoperative pathology.Two patients suffered from postoperative anastomotic leakage and were discharged after conservative treatment.Postoperative follow-up time was 6 months or more,and no complications such as anastomotic hemorrhage,stenosis or recurrence occurred.Conclusions:The total laparoscopic radical gastrectomy for Siewert typeⅡgastroesophageal junction adenocarcinoma via the transabdominal-hiatal approach is safe and effective.