腹腔镜食管胃结合部腺癌手术下纵隔淋巴结清扫范围与技巧

Extent and technique of laparoscopic lower mediastinal lymphadenectomy for adenocarcinoma of esophagogastric junction

食管胃结合部腺癌(AEG)是一种特殊类型的肿瘤,其发病位置特殊,区别于胃癌和食管癌,具有独特的生物学行为。淋巴结转移是AEG最常见的转移途径之一,淋巴结转移可向口侧的下纵隔淋巴结及肛侧的腹腔淋巴结发生转移,因此,AEG病人行根治性手术时除了常规清扫腹腔淋巴结外,下纵隔淋巴结也应该被列入清扫范围,但是对于下纵隔淋巴结清扫的适用人群、清扫范围和手术入路目前仍缺乏高级别的证据支持。由于目前仍然存在争议,加之下纵隔淋巴结位置较高,清扫难度较大,一般只在部分有经验的中心开展。

Adenocarcinoma of esophagogastric junction(adenocarcinoma of esophagogastric junction,AEG)is a special type of tumor with a special location,different from gastric cancer and esophageal cancer,and with unique biological behavior.Lymph node metastasis is one of the most common metastatic routes of AEG,and lymphatic metastasis can occur to the lower mediastinal lymph nodes on the oral side and the abdominal lymph nodes on the anal side.Therefore,in addition to the routine dissection of abdominal lymph nodes,the lower mediastinal lymph nodes should be included in the scope of the dissection for patients with AEG undergoing radical surgery.However,there is still a lack of high-level evidence to support the applicability of lower mediastinal lymph node dissection,the scope of dissection,and the surgical approach,and therefore there is still controversy,coupled with the fact that the lower mediastinal lymph nodes are located at a high level,which makes dissection difficult and is usually performed only in some experienced centers.