腹腔镜辅助手术治疗SiewertⅠ型食管胃结合部腺癌的疗效评价  

Efficacy evaluation of laparoscopy-assisted surgery for Siewert adenocarcinoma of the esophagogastric junction

作　　者：方卫民[1] 陈元美[1] 朱坤寿[1] 

机构地区：[1]福建省肿瘤医院胸外科,福州350014

出　　处：《中华胃肠外科杂志》2014年第5期476-479,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的：探讨腹腔镜辅助手术治疗SiewertⅠ型食管胃结合部腺癌（AEJ）的安全性及临床效果。方法回顾性分析2008年3月至2013年3月间在福建省肿瘤医院接受腹腔镜辅助手术治疗的36例SiewertⅠ型AEJ患者的临床资料。手术入路采用不断肋弓的左侧胸腹单开切口，腹腔镜下行腹腔淋巴结清扫术，并经左胸行下纵隔淋巴结清扫术，消化道重建方式为食管-胃后壁端侧吻合。结果所有患者均手术成功，无一例患者住院期间死亡。手术时间（216．4±46．0） min，术中出血量（252．1±41．1） ml，淋巴结清扫数（30．7±3．2）枚，均为R0切除。术后并发症发生率为16．7％（6／36），均经保守治疗痊愈。淋巴结转移率为50．0％（18／36），其中第1、2、3、7、9、110和111组淋巴结转移率均超过10％。术后中位随访时间为25月，术后3年总体生存率为48．0％。结论腹腔镜辅助手术治疗SiewertⅠ型AEJ安全而有效。Objective To evaluate the safety and efficacy of laparoscopy-assisted surgery for SiewertⅠadenocarcinoma of the esophagogastric junction（AEJ）. Methods Clinical data of 36 patients who underwent left transthoracic dissection of lower mediastinal lymph node followed by laparoscopy D2 lymph node dissection for SiewertⅠAEJ in the Fujian Provincial Cancer Hospital between March 2008 and March 2013 were analyzed retrospectively. A left thoracic-abdominal single incision was used without transection of costal arch. Celiac lymph nodes dissection was performed laparoscopially followed by left transthoracic dissection of lower mediastinal lymph node. Digestive tract reconstruction was carried out by esophagus-gastric posterior wall end-to-side anastomosis. Results Laparoscopy-assisted surgery was successfully achieved in all the 36 patients and there were no in-hospital deaths. The mean operation time, blood loss and number of harvested lymph node were （216.4±46.0） min, （252.1±41.1） ml and 30.7±3.2 respectively. All the procedures were R0 resections. The complication rate was 16.7%（6/36）. All the complications were managed by conservative treatment, and there were no re-operations. The lymphatic metastasis rate was 50.0%（18/36）, and the lymph node groups with high metastatic rate （all＆gt; 10.0%） were groups 1, 2, 3, 7, 9, 110 and 111. The median follow-up was 25 months. The overall 3-year survival was 48.0%. Conclusion Laparoscopy-assisted surgery for SiewertⅠAEJ is safe and feasible.

关 键 词：食管胃交界腺癌 SiewertⅠ型 淋巴结清扫 腹腔镜 手术径路 ADENOCARCINOMA of the esophagngastric junction Siewert typeⅠ 

分 类 号：R735.1[医药卫生—肿瘤]