回归基础解剖探索食管胃结合部肿瘤外科治疗的困惑与争议

Analysis of the clinical confusion and controversy of esophagogastric junction tumor from basic anatomy

食管胃结合部肿瘤的外科治疗在手术入路、清扫范围、切除范围等方面尚存在较多争议,对食管胃结合部范围的认知差异是造成这一现象的主要原因。该部位现有的解剖学阐述已无法满足临床实践的需要。基于大量基础解剖和临床操作,食管胃结合部可能是由完整、单独的食管胃结合部膜所包裹的有独立解剖结构的移行组织,从黏膜下静脉分布入手,可以了解该区域组织移行变化的意义及其与临床操作的关系,根据这些解剖特点,可以对当前的争议进行合理的分析,期待与同道一起进一步深入研究。

There are still many controversies in the surgical treatment of esophagogastric junction tumors in terms of surgical approach,cleaning range,and resection scope.The reason is the confusion about the scope of the esophagogastric junction.The previous domestic and foreign anatomy descriptions of this part are not enough to solve the current problems.Based on a large number of basic anatomy and clinical operations,this article proposes that the esophagogastric junction may be wrapped by a complete and separate esophagogastric junction membrane with independent anatomy other than infracardiac bursa.The structure of the transitional tissue,mainly from the distribution of submucosal veins,explained the relationship and significance of tissue transitional changes and clinical operations,and made a reasonable analysis of the current controversy based on the anatomical characteristics,which is worthy of further investigation.