基于Siewert分型:Ⅱ型食管胃结合部腺癌的争议进展

Based on Siewert classification:controversy progress of the integration of typeⅡof adenocarcinoma of esophagogastric junction

目的对近几年食管胃结合部腺癌(AEG)在分期、手术治疗、腔镜治疗及辅助治疗等方面的研究进展予以梳理总结,为该疾病后续的相关研究及治疗提供参考帮助。方法采取文献复习的方法,查阅各大数据库有关AEG治疗相关文献,进行梳理归纳。结果AEG近年来发病率迅速上升,其恶性度高,预后差。Siewert分型使学者能深入了解该疾病,其治疗方式也逐渐多元化。目前,其主要治疗方式仍为根治性外科手术。由于AEG毗邻食管及胃,导致其在分期、手术径路、切除范围、消化道重建方式、辅助治疗等多方面存在争议,尤其是SiewertⅡ型。结论SiewertⅡ型在手术径路、切除范围及腹腔镜手术选择方面可以根据食管受累距离进行判断,病理分期尚无定论,还需要更多的研究以达成共识。随着腹腔镜及辅助治疗的应用,如何选择个体化的治疗方案需要多学科协作进一步研究。

Objective To review and summarize the research progress of adenocarcinoma of esophagogastric junction(AEG)in staging,surgical treatment,endoscopic treatment and adjuvant therapy in recent years,so as to provide reference and help for the follow-up research and treatment of this disease.Method Literature review was used to review the literatures on AEG treatment in various databases.Results The incidence of AEG had increased rapidly in recent years,with high malignancy and poor prognosis.Siewert typing had allowed researchers to gain insight into the disease,and treatments were increasingly diversified.At present,the main treatment was still radical surgery.Because AEG was adjacent to the esophagus and stomach,there were many controversies about its staging,surgical approach,resection range,digestive tract reconstruction,adjuvant treatment and so on,especially Siewert typeⅡ.Conclusions The surgical approach,resection range,and laparoscopic surgery of Siewert typeⅡcan choose according to esophageal involvement distance judgment,pathological staging is uncertain,still need several studies to reach a consensus.With the application of laparoscopy and adjuvant therapy,how to select individualized treatment options that require multidisciplinary collaboration for further study.