完全腹腔镜下经腹入路与经腹联合开胸手术入路治疗SiewertⅡ型食管胃结合部腺癌的对比研究  

A comparative study of complete laparoscopic transabdominal approach and transabdominal combined thoracotomy approach in treatment of Siewert typeⅡesophageal gastric junction adenocarcinoma

作　　者：宋舜尧 韩璐 袁庆忠[3] 孙作成[4] SONG Shunyao;HAN Lu;YUAN Qingzhong;SUN Zuocheng(Weifang Medical University,Weifang,Shandong 261000,P.R.China;The First Affiliated Hospital of Weifang Medical University/Three Health Care Departments of Weifang People’s Hospital,Weifang,Shandong 261000,P.R.China;Hepatobiliary Surgery,Shengli Oilfield Central Hospital,Dongying,Shandong 257000,P.R.China;The First Affiliated Hospital of Weifang Medical University/The First Ward of General Surgery(Gastrointestinal Surgery)of Weifang People’s Hospital,Weifang,Shandong 261000,P.R.China)

机构地区：[1]潍坊医学院,山东潍坊261000 [2]潍坊医学院第一附属医院/潍坊市人民医院保健三科,山东潍坊261000 [3]胜利油田中心医院肝胆外科,山东东营257000 [4]潍坊医学院第一附属医院/潍坊市人民医院普外科(胃肠外科)一区,山东潍坊261000

出　　处：《中国普外基础与临床杂志》2020年第10期1259-1265,共7页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨完全腹腔镜下经腹食管裂孔入路与经腹联合开胸手术入路治疗对SiewertⅡ型食管胃结合部腺癌(AEG)围手术期疗效及生存预后的影响。方法回顾性收集2012年1月至2014年12月期间在潍坊市人民医院普外科(胃肠外科)诊断为SiewertⅡ型AEG患者,根据手术入路方式分为经腹入路组(经腹组)和经腹联合开胸手术入路组(经胸腹组),比较2组患者的术中及术后情况。结果本研究共纳入142例AEG患者,经腹组83例,经胸腹组59例,2组患者的性别、年龄、组织学分化程度、TNM分期等基线资料比较差异无统计学意义(P>0.05)。在手术时间、术中出血量及输血量以及输血患者比例方面,经腹组均优于经胸腹组(P<0.05);在术后住院时间、镇痛药应用时间、首次下床活动时间、撤离心电监护时间方面,经腹组亦早于经胸腹组(P<0.05);2组患者均无近端手术切口阳性;经腹组清扫淋巴结数量和淋巴结转移数量较经胸腹组少(P<0.05),但2组淋巴结阳性率比较差异无统计学意义(P>0.05);经腹组总并发症发生率较经胸腹组更低(χ^2=9.871,P=0.002)。经腹组中位生存时间39个月,经胸腹组中位生存时间34个月,2组患者的生存情况经Kaplan-Meier分析未发现差异无统计学意义(χ^2=0.281,P=0.596)。多因素分析结果发现,肿瘤TNM分期和淋巴结阳性率是影响SiewertⅡ型AEG患者生存预后的独立影响因素。结论从本研究结果看,SiewertⅡ型AEG患者采用经腹食管裂孔入路与经胸腹联合入路相比,手术时间更短,术后并发症更少,围术期预后更佳,对于部分高龄合并心肺功能较差、不能耐受经胸手术的患者可选择完全腹腔镜下经腹食管裂孔入路安全性更高。Objective To investigate therapeutic effect and influence on survival of complete laparoscopic transesophageal hiatus approach approach and transabdominal combined thoracotomy approach in treatment of Siewert typeⅡesophageal gastric junction adenocarcinoma(AEG).Methods From January 2012 to December 2014,the patients with Siewert typeⅡAEG were collected in the Department of General Surgery(Gastrointestinal Surgery)of Weifang People’s Hospital,then who were designed into a transabdominal group and transabdominal combined thoracotomy group according to the operative approach method.The intraoperative and postoperative statuses were compared between these two groups.Results In this study,142 patients with Siewert type Ⅱ AEG were included,83 in the transabdominal group and 59 in the transabdominal combined thoracotomy group.There were no significant differences in the baseline data such as the gender,age,preoperative histological differentiation,TNM stage,etc.between the two groups(P>0.05).Compared with the transabdominal combined thoracotomy group,in terms of the operation time,the volumes of intraoperative blood loss and blood transfusion,and the proportion of patients with blood transfusion were better(P<0.05);the postoperative hospitalization time,time to use analgesics,time of the first activity out of bed,and time of removed electrocardiographic monitoring were also earlier(P<0.05);the numbers of lymphadenectomy and metastatic lymph nodes were less(P<0.05)in the transabdominal group.But there was no significant difference in the rate of lymph node metastasis between the two groups(P>0.05).The total incidence of complications in the transabdominal group was lower than that in the transabdominal combined thoracotomy group(χ^2=9.871,P=0.002).The median survival time was 39 months in the transabdominal group and 34 months in the transabdominal combined thoracotomy group.The survival had no significant difference between the two groups by the Kaplan-Meier analysis(χ^2=0.281,P=0.596).The result of multivaria

关 键 词：食管胃结合部腺癌 SiewertⅡ型 完全腹腔镜 经腹食管裂孔入路 经腹联合开胸手术入路 安全性 

分 类 号：R735[医药卫生—肿瘤]