食管胃结合部腺癌经胸路径手术的利与弊

Advantages and disadvantages of transthoracic approach for adenocarcinoma of the esophagogastric junction

食管胃结合部腺癌(AEG)由于具有跨越两个器官和解剖部位的解剖特点,胸外科和胃肠外科针对食管的安全切缘、下纵隔淋巴结清扫范围和经胸手术是否会增加并发症等问题,而在AEG的手术路径、手术方式、淋巴结清扫和切除范围等方面存在较大的分歧和争议。对于SiewertⅡ型AEG经腹纵隔入路手术,往住由于视野暴露及操作难度的原因,近切缘很难达到满意的长度,进行下纵隔淋巴结清扫难度极大。而经胸入路能获得直观的视野暴露,降低操作难度,获得满意的食管安全切缘和进行下纵隔淋巴结清扫,可能使患者获得更好的预后。尽管经胸入路可能会增加肺部感染的发生率,但腔镜技术的规范开展会克服SiewertⅡ型AEG经胸入路的这一劣势。

Adenocarcinoma of the esophaogastric junction(AEG)has anatomical characteristics of spanning two organs and anatomical sites.Thoracic surgery and gastrointestinal surgery aim at the safe resection margin of esophagus,the scope of lower mediastinal lymph node dissection and whether transthoracic surgery will increase complications.However,there are great differences and controversies in the surgical approach,surgical method,lymph node dissection and extent of resection of AEG.For Siewert II AEG via abdominal mediastinal approach,due to the limitation of exposure and the difficulty of operation,it is difficult to acquire a satisfactory proximal resection margin,and very difficult to dissect the inferior mediastinal lymph nodes.The transthoracic approach can provide adequate exposure,reduce the difficulty of operation,obtain satisfactory resection margin of esophagus and allow lower mediastinal lymph node dissection,which may bring better prognosis.Although transthoracic approach may increase the incidence of pulmonary infection,the standard development of thoracoscopic technology will overcome the disadvantage of transthoracic approach for Siewert II AEG.