腹腔镜下经腹食管裂孔入路手术治疗老年SiewertⅡ型食管胃结合部腺癌患者疗效观察

Curative Effect of Laparoscopic Transabdominal-hiatal Approach Surgery in Elderly Patients with Siewert TypeⅡAdenocarcinoma of Esophageal-gastric Junction

目的:观察腹腔镜下经腹食管裂孔入路手术治疗老年SiewertⅡ型食管胃结合部腺癌(AEG)患者的短期疗效。方法:回顾性分析2020年9月~2023年6月在本院收治的134例老年SiewertⅡ型AEG患者,根据患者手术方式将其分为开腹组(82例,开腹根治性全胃切除术)与腔镜辅助组(52例,腹腔镜根治性全胃切除术)。比较两组一般资料,手术时间、手术出血量、下纵隔淋巴结清扫情况、淋巴结阳性数等围手术期指标。结果:与开腹组比较,腔镜辅助组手术时间更长,手术出血量、术后排气时间、术后排便时间、术后进食时间、腹腔引流管拔除时间和术后住院时间更短(P<0.05)。术前,腔镜辅助组和开腹组血清相关指标相当(P>0.05);术后3个月,两组血红蛋白和血清白蛋白较术前均有所下降,术后6个月,两组血红蛋白和血清白蛋白又有所回升(P<0.05);但两组各时间点指标比较无差异(P>0.05)。结论:虽然经腹食管裂孔入路腹腔镜手术治疗老年SiewertⅡ型AEG患者较开腹手术治疗手术时间更长,但患者术后恢复越快,且两种手术方式在术后并发症及短期疗效等方面具有相似的临床效果。

Objective:To observe short-term curative effect of laparoscopic transabdominal-hiatal approach surgery in elderly patients with Siewert typeⅡadenocarcinoma of esophageal-gastric junction(AEG).Methods:A total of 134 elderly patients with Siewert typeⅡAEG in the hospital were retrospectively analyzed between September 2020 and June 2023.According to different surgical methods,they were divided into laparotomy group(82 cases,open radical total gastrectomy)and laparoscopic assistance group(52 cases,laparoscopic radical total gastrectomy).The general data,perioperative indexes(operation time,intraoperative blood loss,lower mediastinal lymph node dissection,number of positive lymph nodes),hemoglobin and serum albumin before surgery.Results:Compared with laparotomy group,operation time was longer in laparoscopic assistance group,intraoperative blood loss,postoperative exhaust time,postoperative defecation time,postoperative eating time,postoperative extubation time and hospitalization time were lower(P<0.05).Before surgery,there was no significant difference in serum indexes between the two groups(P>0.05).At 3 months after surgery,levels of hemoglobin and serum albumin were decreased in both groups,but which were increased again at 6 months after surgery(P<0.05),and the difference between the two groups was not statistically significant(P>0.05).Conclusion:Compared with laparotomy,although laparoscopic transabdominal-hiatal approach surgery has longer operation time,the postoperative recovery is faster in patients with Siewert typeⅡAEG.The two surgical methods have similar clinical effects in terms of postoperative complications and short-term curative effect.