腹腔镜辅助与开腹近端胃切除对SiewertⅡ型和Ⅲ型食管胃结合部腺癌疗效比较  

Comparison of the efficacies of laparoscopic-assisted and open proximal gastrectomy for the treatment of Siewert typeⅡand Ⅲadenocarcinoma of the esophagogastric junction

作　　者：贾建光[1] 李雷[1] 李靖[1] 王益民[1] 姚廷敬[1] 谢波[1] 岳喜成[1] 王亚国[1] 钱军[1] Jianguang Jia;Lei Li;Jing Li;Yimin Wang;Tingjing Yao;Bo Xie;Xicheng Yue;Yaguo Wang;Jun Qian(The First Affiliated Hospital of Bengbu Medical College,Department of Oncology Surgery,Bengbu 233000,China This work was supported by the Key Project of Anhui Provincial Education Department（No.KJ2017A240)

机构地区：[1]蚌埠医学院第一附属医院肿瘤外科,安徽省蚌埠市233000

出　　处：《中国肿瘤临床》2018年第15期780-784,共5页Chinese Journal of Clinical Oncology

基　　金：安徽省教育厅重点项目(编号:KJ2017A240)资助~~

摘　　要：目的:研究腹腔镜辅助近端胃切除术(laparoscopic-assisted proximal gastrectomy,LAPG)和开腹全胃切除术(open proximalgastrectomy,OPG)治疗SiewertⅡ型和Ⅲ型食管胃结合部腺癌(adenocarcinoma of the esophagogastric junction,AEG)的临床疗效。方法:回顾性分析蚌埠医学院第一附属医院2015年2月至2017年2月收治的116例行近端胃切除的SiewertⅡ型和Ⅲ型AEG患者的临床资料,其中LAPG组48例、OPG组68例。分析两组患者的临床病理特征、术中情况、根治效果与肿瘤复发情况。结果:两组患者手术均顺利完成,无围手术期死亡。LAPG组患者平均手术时间为(3.46±0.46)h,长于OPG组的(2.68±0.68)h;平均术中出血量为(108±46.8)mL,少于OPG组的(236±86.6)mL;胃肠功能恢复时间为(2.56±0.56)d,短于OPG组的(3.82±0.86)d;术后平均住院时间为(12.24±1.86)d,少于OPG组的(14.68±2.89)d;近端切缘(3.06±0.56)cm长于OPG组的(2.38±0.68)cm(均P<0.05)。两组患者的清扫淋巴结数目、远端切缘、术后并发症发生率,差异均无统计学意义(P>0.05)。结论:LAPG在治疗SiewertⅡ型和Ⅲ型AEG患者的根治效果、术后并发症及肿瘤复发方面与开放手术相当;LAPG具有术中出血少、胃肠功能恢复快、住院时间短的优势,近端切缘更长。To compare the clinical efficacies of laparoscopic-assisted proximal gastrectomy（LAPG） and open proximal gastrectomy（OPG） for treating Siewert type II and III adenocarcinoma of the esophagogastric junction（AEG）. Methods： The clinical data of 116 patients with Siewert type II and III AEG from February 2015 to February 2017 were analyzed retrospectively. Patients were grouped into the LAPG group（48 cases） and the OPG group（68 cases）. The efficacy of radical resection, clinicopathological features, perioperative situation, and postoperative tumor recurrence in the two groups were compared. Patients were followed up by telephone or out-patient examination until March 2018. Results： The two groups of patients successfully underwent surgery with no perioperative death.The average operation time was（3.46±0.46） h in the LAPG group, which was longer than that in the OPG group（2.68±0.68） h. The average intraoperative bleeding volume was（108±46.8） mL, which was lower than that in the OPG group（236±86.6） mL. The gastrointestinal function recovery time was（2.56±0.56） d in the LAPG group, which was shorter than that in the OPG group（3.82±0.86） d. The average hospital stay was（12.24 ± 1.86） d in the LAPG group, which was lower than that in the OPG group [（14.68 ± 2.89） d; P0.05]. The proximal incision margin was longer in OPG group [（3.06±0.56） cm vs.（2.38±0.86） cm, P0.05]. There were no significant differences in the length of distal resection margins, number of lymph nodes resected, and incidence of postoperative complications between the LAPG and OPG groups（P0.05）. Conclusions： LAPG is comparable to OPG in the treatment of Siewert type Ⅱ and ⅢAEG regarding the aspects of radical resection and tumor recurrence, but LAPG confers less bleeding, less postoperative pain, faster recovery of gastrointestinal function, and shorter hospital stay.

关 键 词：食管胃接合部腺癌 腹腔镜 胃切除术 治疗结果 

分 类 号：R735[医药卫生—肿瘤]