食管胃结合部腺癌外科治疗的几个主要问题

Several issues on surgical treatment for adenocarcinoma of esophagogastric junction

食管胃结合部腺癌(AEG)的外科治疗尚存诸多争议与问题。当前,临床常用Siewert分型和TNM分期辅助临床决策和预后判断。经胸入路更适用于SiewertⅠ型及食管侵犯较长的患者,而经腹食管裂孔入路适用于SiewertⅢ型患者。AEG最优淋巴结清扫范围应基于肿瘤位置和食管侵犯程度等合理决策。手术切除范围及消化道重建方式应以肿瘤根治和保障手术安全为原则,并充分考虑患者术后生活质量。全胃切除术后,Roux-en-Y吻合是最常见且高效的吻合方式;近端胃切除术后,双通道吻合获得较多专家推荐。随着微创外科技术的不断推进,经验丰富的中心和团队可开展全腔镜下的消化道重建。未来,期待更多的高质量研究为AEG的外科治疗决策提供循证医学证据。

There are several controversies and issues in the surgical treatment of esophagogastric junction(AEG)currently.The Siewert classification and TNM staging system are commonly used to assist clinical decision and prognosis prediction.Generally,transthoracic procedure is more suitable for SiewertⅠtype and longer esophageal invasion patients,while transhiatal is more suitable for SiewertⅢtype patients.The optimal extent of lymph node dissection for AEG should be based on tumor location and esophageal invasion range.The extent of surgical resection and the method of digestive tract reconstruction should be based on the principle of radical resection and surgical safety,and the postoperative life quality of patients should be fully considered.Roux-en-Y anastomosis is the most common and efficient anastomosis after total gastrectomy,while double tract anastomosis is recommended by many experts after proximal gastrectomy.With the continuous advancement of minimally invasive techniques,experienced centers and teams can perform digestive tract reconstruction under total laparoscopy.In the future,more high-quality studies are expected to provide evidence-based medical evidence for AEG′s surgical treatment decisions.