食管胃交界部腺癌SiewertⅠ型和Ⅱ型胸外科手术的治疗效果及其预后

Therapeutic Effect and Prognosis of Siewert Type Ⅰ and Type Ⅱ Thoracic Surgery for Esophageal and Gastric Junction Adenocarcinoma

目的 探讨SiewertⅠ型和Ⅱ型食管胃交界部腺癌(AEG)胸外科手术治疗效果及预后。方法 回顾性分析184例SiewertⅠ型和Ⅱ型AEG患者临床资料,其中SiewertⅠ型80例,经胸腹入路手术48例,经胸入路手术32例;SiewertⅡ型104例,经胸腹入路手术71例,经胸入路手术33例。比较SiewertⅠ型和Ⅱ型AEG手术相关指标以及术后3年、5年生存率差异,以及两者不同手术入路生存率差异。结果 与经胸腹入路组相比,经胸入路组手术用时短,术中失血量少,呼吸系统并发症发生率高,差异有统计学意义(P<0.05);两种入路手术后循环系统并发症和吻合口瘘发生率比较,差异无统计学差异(P>0.05)。SiewertⅠ型患者3年生存率为36.25%、5年生存率为25.00%,SiewertⅡ型3年、5年生存率分别为41.35%、29.81%,不同类型患者术后生存率比较,差异无统计学意义(P>0.05)。SiewertⅠ型:经胸入路者3年生存率为40.63%、5年生存率为21.88%,经胸腹入路者3年生存率为33.33%、5年生存率为27.08%,差异无统计学意义(P>0.05);SiewertⅡ型:经胸入路者3年生存率为33.33%、5年生存率为27.274%,经胸腹入路者3年生存率为45.07%、5年生存率为30.99%,差异无统计学意义(P>0.05)。结论 经胸入路手术治疗SiewertⅠ型和Ⅱ型AEG用时短、出血少,而经胸腹入路手术术后呼吸系统并发症发生率低,临床可根据患者病情选择适宜的手术入路。

Objective To investigate Siewert typeⅠand typeⅡesophageal gastric junction adenocarcinoma(AEG)therapeutic effect and prognosis of thoracic surgery.Methods Clinical data of 184 patients with Siewert typeⅠand typeⅡAEG were analyzed retrospectively,including 80 cases of Siewert typeⅠ,48 cases of transthoracic abdominal surgery,32 cases of transthoracic surgery,104 cases of Siewert typeⅡ,71 cases of transthoracic abdominal surgery and 33 cases of transthoracic surgery.Siewert typeⅠand related indexes of typeⅡAEG operation,the difference of 3-year and 5-year survival rates,and the difference of survival rates of different surgical approaches were compared.Results Compared with the transthoracic abdominal approach group,the transthoracic approach group had shorter operation time,less intraoperative blood loss and higher incidence of respiratory complications,The difference was statistically significant(P<0.05),and there was no significant difference in the incidence of circulatory complications and anastomotic leakage between the two approaches(P>0.05);the 3-year and 5-year survival rates of Siewert typeⅠpatients were 36.25%and 25.00%,and the 3-year and 5-year survival rates of Siewert typeⅡpatients were 41.35%and 29.81%respectively.There was no significant difference in the postoperative survival rates of different types of patients(P>0.05);Siewert typeⅠ:the 3-year survival rate of transthoracic approach was 40.63%,the 5-year survival rate was 21.88%,and the 3-year survival rate of transthoracic abdominal approach was 33.33%,the 5-year survival rate was 27.08%(P>0.05);Siewert typeⅡ:the 3-year survival rate of transthoracic approach was 33.33%,the 5-year survival rate was 27.274%,and the 3-year survival rate of transthoracic abdominal approach was 45.07%,the 5-year survival rate was 30.99%(P>0.05).Conclusion Transthoracic approach for Siewert typeⅠand typeⅡAEG takes less time and bleeding,while transthoracic abdominal approach has a low incidence of respiratory complications.The appropriate surgical approach can be selected according to the patient's condition.