食管胃结合部腺癌保功能手术的现状和发展

Current status and development status of functional preserving surgery for adenocarcinoma of esophagogastric junction

食管胃结合部腺癌是消化系统常见肿瘤,其发生率呈进行性上升。传统经腹食管裂孔路径的食管胃结合部腺癌根治手术多采用全胃切除术。随着早期病人的比例增加,保功能手术观念的发展及更多的研究数据支持,近端胃切除术在早期食管胃结合部腺癌中越来越得到重视。食管胃结合部腺癌的近端胃切除术的两个重要研究方向:一是食管胃结合部腺癌的适应证研究,主要涉及淋巴结转移、切缘要求等;二是消化道重建的术式选择研究,主要基于增加残胃的容受、重建结构屏障或压力屏障、加速胃排空三个基本原理进行重建术式的设计。笔者希望通过对两个研究方向的探讨,为食管胃结合部腺癌保功能手术的发展提供一些方向。

Adenocarcinoma of esophagogastric junction(AEG)is a common tumor of digestive system and its incidence has been rising steadily.Total gastrectomy is indicated for traditional radical resection of cancer at the junction of esophagus and stomach via the route of abdominal esophageal hiatus.With a growing proportion of early patients,the concept of functional preserving surgery has been supported by ongoing researches.Proximal gastrectomy is preferred for early stage of AEG.There are two important research directions of proximal gastrectomy for AEG.One is indication research mainly involving lymph node metastasis and requiring resection margin.The second focuses upon selecting surgical approaching for digestive tract reconstruction.It is based upon three basic principles of boosting the tolerance of remnant stomach,rebuilding structural barrier or pressure barrier and accelerating gastric emptying.