SiewertⅡ型进展期食管胃结合部腺癌近端切缘长度与近期临床疗效观察  

Proximal incisal edge length and recent clinical observation of Siewert typeⅡadvanced esophagogastric junction adenocarcinoma

作　　者：梅相煌 王洋洋 郭伟[1] 李文媛[3] 王宇[1] 毕志彬[1] 何志鹏 苏石 韩明 张晋杰 秦小卫 Mei Xianghuang;Wang Yangyang;Guo Wei;Li Wenyuan;Wang Yu;Bi Zhibin;He Zhipeng;Su Shi;Han Ming;Zhang Jinjie;Qin Xiaowei(Department of Gastrointestinal Surgery,Heji Hospital,Changzhi Medical College,Changzhi 046000,China;Changzhi Medical College,Changzhi 046000,China;Department of Pharmacy,Changzhi Medical College,Changzhi 046000,China)

机构地区：[1]山西长治医学院附属和济医院胃肠外科,长治046000 [2]山西长治医学院研究生院,长治046000 [3]山西长治医学院药学系,长治046000

出　　处：《中华医学杂志》2021年第34期2698-2702,共5页National Medical Journal of China

基　　金：山西省自然科学基金(201901D111331)。

摘　　要：目的探讨SiewertⅡ型进展期食管胃结合部腺癌根治术中近端切缘距离为20~25 mm与30~35 mm的近期临床疗效,以期将近端切缘最小安全距离缩短至20~25 mm。方法采用回顾性队列研究方法。回顾性收集2017年1月至2020年8月长治医学院附属和济医院胃肠外科收治的166例[男112例,女54例;年龄(59.1±9.6)岁]SiewertⅡ型进展期食管胃结合部腺癌行全胃切除后患者的临床资料,根据近端切缘长度,分为近端切缘20~25 mm组(69例)和近端切缘30~35 mm组(97例),比较两组患者围手术期情况及术后6个月随访情况。结果两组患者基线资料比较,差异均无统计学意义(均P>0.05),两组患者均顺利完成手术。术中手术时间的比较,近端切缘20~25 mm组[(172±24)min]短于近端切缘30~35 mm组[(206±27)min](P<0.001);两组患者术中出血量、术中膈肌脚处理情况及术中上切缘冰冻阳性率情况比较,差异均无统计学意义(均P>0.05)。两组术后首次排气时间、术后拔除胃管时间、术后首次进食时间、术后住院天数比较,差异均无统计学意义(均P>0.05);近端切缘20~25 mm组与近端切缘30~35 mm组术后吻合口瘘、吻合口狭窄、反流性食管炎、肠梗阻发生率的比较,差异均无统计学意义(均P>0.05),其中近端切缘20~25 mm组无吻合口瘘发生;术后病理处理两组标本的脉管癌栓及神经浸润情况差异无统计学意义(均P>0.05)。术后6个月随访中,两组患者均无死亡及肿瘤复发情况出现,术后6个月体重下降比较差异无统计学意义(P=0.178)。结论SiewertⅡ型进展期食管胃结合部腺癌行根治性切除治疗时,在保证R0切除的前提下,将近端切缘最小安全距离缩短至20~25 mm是可行的,且术后吻合口瘘发生率也有所降低。Objective To investigate the clinical effect of the radical resection with a proximal incisal edge length of 20-25 mm and 30-35 mm in Siewert typeⅡadvanced esophagogastric junction adenocarcinoma,to shorten the minimum safe distance of the proximal incisal edge to 20-25 mm.Methods A retrospective cohort study method was used.The clinical data of 166 patients with Siewert typeⅡadvanced esophagogastric junction adenocarcinoma who underwent total gastrectomy from January 2017 to August 2020 in the Department of Gastrointestinal Surgery,Heji Hospital Affiliated to Changzhi Medical College were retrospectively collected.According to the proximal incisal edge length,the patients were divided into two groups:the proximal incisal edge length of 20-25 mm group(69 cases)and 30-35 mm group(97 cases).The perioperative conditions and the 6-month follow-up after the operation were compared between the two groups.Results There was no statistically significant difference in baseline information between the patients in the two groups(P>0.05).The operations of both groups were completed.The intraoperative operation time of the proximal incisal edge length of 20-25 mm group was shorter than that in the proximal incisal edge length of 30-35 mm group((172±24)and(206±27)min,P<0.001).There were no significant differences in the amount of intraoperative blood loss,the treatment of the diaphragm during the operation and the positive rate of intraoperative freezing of the upper incisal edge between the patients in the two groups(all P>0.05).And there was no significant differences in the first exhaust time,gastric tube removal time,first feeding time and hospital stay after the operation of the two groups(all P>0.05).There was no significant differences in the incidence of anastomotic leakage,anastomotic stenosis,reflux esophagitis and intestinal obstruction after the operation between the patients in the two groups(all P>0.05).And there was no anastomotic leakage case among the 69 cases in the proximal incisal edge length of 20-25

关 键 词：食管胃接合处 腺癌 SiewertⅡ型 进展期 近端切缘距离 吻合口瘘 

分 类 号：R735.2[医药卫生—肿瘤]