腹腔镜辅助双通道重建术治疗食管胃交界部腺癌  

Analysis of the safety and efficacy of laporascopy-assisted jejunal interposition restrictive double-tract reconstruction in patients with adenocarcinoma of esophagogastric junction

作　　者：查鹏 刘军强 宋伟安 岳彩迎 赵嘉华 范博士 王振华 陈思禹 龚太乾 CHA Peng;LIU Junqiang;SONG Weian;YUE Caiying;ZHAO Jiahua;FAN Boshi;WANG Zhenhua;CHEN Siyu;GONG Taiqian(Department of Thoracic Surgery,the Sixth Medical Center,Chinese PLA General Hospital,Beijing 100048,China)

机构地区：[1]中国人民解放军总医院第六医学中心胸外科

出　　处：《转化医学杂志》2019年第3期153-156,共4页Translational Medicine Journal

基　　金：国家自然科学基金(81372556)

摘　　要：目的 探讨腹腔镜辅助限制性双通道重建术治疗食管胃交界部腺癌的安全性和可行性。方法 2010年1月—2018年12月,解放军总医院第六医学中心胸外科共收治符合入排标准的89例患者,并按临床信息进行倾向匹配分析后纳入78例,其中左侧开胸手术52例(对照组),腹腔镜辅助限制性双通道空肠重建术26例(观察组)。回顾性分析患者的基线资料、手术资料及术后并发症资料。结果 观察组手术时间(229.32±51.37)min,术中出血量(431.11±332.87)mL,清扫淋巴结数量(26.72±9.51)个。2组患者手术时间、术中出血量差异比较无统计学意义(P>0.05),观察组的清扫淋巴结数量多于对照组,差异比较有统计学意义(P=0.002)。观察组的并发症发生率显著低于对照组,差异比较有统计学意义(P=0.003),严重并发症发生率低于对照组,但差异比较无统计学意义(P>0.05)。结论 与左侧开胸手术比较,腹腔镜辅助限制性双通道空肠重建术可以减少术后并发症,改善淋巴结清扫,预期能改善食管胃交界部腺癌患者预后。Objective To investigate the safety and feasibility of laporascopy-assisted jejunal interposition restrictive double-tract reconstruction in patients with adenocarcinoma of esophagogastric junction( AEGJ). Methods From January 2010 to December 2018,eighty nine patients underwent surgical resection in Department of Thoracic Surgery of the Sixth Medical Center,Chinese PLA General Hospital met the inclusion and exclusion criteria,and then seventy eight patients were included after propensity-matched-analysis. Fifty two patients underwent thoracotomy surgical resection of AEGJ and intra-thoracic gastroesophageal anastomosis( control group),and twenty six patients underwent laporascopy-assisted surgical resection of AEGJ,jejunal interposition restrictive doubletract reconstruction( observation group). Parameters such as baseline characteristics,surgical data,postoperative recovery and postoperative complications of patients with AEGJ underwent surgical resection were recorded and analyzed. Results In observation group,the length of operation was( 229. 32±51. 37) min,the blood loss of operation was( 431. 11±332. 87) m L,and the number of dissected lymph nodes was( 26. 72±9. 51). There was no significant difference of length of operation and blood loss of operation between the two groups( P >0. 05). And the quantity of dissected lymph nodes in the observation group was significantly more than that of the control group( P = 0. 002).There was significantly reduced morbidity in the observation group( P = 0. 003). Conclusion Compared with thoracotomy surgical resection of esophagogastric junction carcinoma,laporascopy-assisted surgical resection of esophagogastric junction carcinoma,jejunal interposition restrictive double-tract reconstruction can reduce postoperative complications,improve the lymph node dissection and expected can improve the prognosis of patients with AEGJ.

关 键 词：食管胃交界部腺癌 腹腔镜 开胸 双通道重建术 并发症 

分 类 号：R735[医药卫生—肿瘤]