经腹打开左侧膈肌与传统胸腹联合手术入路治疗SiewertⅡ型食管胃结合部腺癌效果比较  

Efficacy comparison of transabdominal opening of the left diaphragm and traditional thoracoabdominal combination surgical approach for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction

作　　者：李宇[1] 雷昊 牛权 毕小刚[2] Li Yu;Lei Hao;Niu Quan;Bi Xiaogang(The Fifth Clinical Medical College of Shanxi Medical University,Taiyuan 030012,China;Department of Gastrointestinal Surgery,Shanxi Provincial People's Hospital,Taiyuan 030012,China)

机构地区：[1]山西医科大学第五临床医学院,太原030012 [2]山西省人民医院胃肠外科,太原030012

出　　处：《肿瘤研究与临床》2024年第5期365-370,共6页Cancer Research and Clinic

摘　　要：目的比较经腹打开左侧膈肌与传统胸腹联合两种手术入路治疗SiewertⅡ型食管胃结合部腺癌的临床效果及预后。方法回顾性队列研究。回顾性分析2018年1月至2020年3月山西省人民医院行根治性全胃切除手术治疗的59例SiewertⅡ型食管胃结合部腺癌患者的临床资料,根据手术入路将患者分为经腹打开左侧膈肌组(30例)和胸腹联合组(29例)。比较两组患者的一般资料、围术期指标、术后并发症及术后生存情况等。采用Cox比例风险模型分析总生存影响因素。结果两组性别、年龄、肿瘤长径、pT分期、pN分期差异均无统计学意义(均P>0.05)。经腹打开左侧膈肌组和胸腹联合组食管受侵长度分别为(3.5±1.1)cm、(3.7±1.1)cm,差异无统计学意义(t=-0.70,P=0.486)。与胸腹联合组相比,经腹打开左侧膈肌组的手术时间、术中出血量、术后卧床时间、胸管拔出时间及术后住院天数均少,差异均有统计学意义(均P<0.05);两组淋巴结清扫数、阳性淋巴结数、胸腔淋巴结清扫数和胸腔阳性淋巴结数比较差异均无统计学意义(均P>0.05)。经腹打开左侧膈肌组和胸腹联合组术后并发症总发生率分别为53.3%(16/30)、72.4%(21/29),差异无统计学意义(χ2=2.30,P=0.130),但胸腹联合组的肺部感染及胸腔积液发生率均高于经腹打开左侧膈肌组(均P<0.05)。经腹打开左侧膈肌组术后1、3年总生存率分别为80.0%、63.3%,胸腹联合组分别为79.3%、62.1%,两组总生存差异无统计学意义(χ2=0.01,P=0.934)。多因素分析显示,pT分期(HR=4.009,95%CI:1.851~8.683,P<0.001)、pN分期(HR=2.338,95%CI:1.435~3.811,P=0.001)为患者总生存的独立影响因素。结论对于食管受侵长度>3 cm的SiewertⅡ型食管胃结合部腺癌患者,经腹打开左侧膈肌入路的术中出血量及术后胸部并发症少,手术及住院时间短,且创伤轻,有助于加速患者康复;pT、pN分期是患者预后的独立影响因素。Objective To compare the clinical outcomes and prognosis of transabdominal opening of the left diaphragm and traditional thoracoabdominal combination approach for Siewert type II adenocarcinoma of the esophagogastric junction.Methods A retrospective cohort study was conducted.The clinical data of 59 patients with Siewert typeⅡadenocarcinoma of the esophagogastric junction who underwent radical total gastrectomy in Shanxi Provincial People's Hospital from January 2018 to March 2020 were retrospectively analyzed,and all patients were divided into the transabdominal opening of the left diaphragm group(30 cases)and the thoracoabdominal combination group(29 cases)according to surgical access.The general data,perioperative indexes,postoperative complications and postoperative survival of patients in the two groups were compared.Factors influencing the overall survival were analyzed by using Cox proportional hazards model.Results The differences in terms of gender,age,tumor diameter,pT staging,and pN staging between the two groups were not statistically significant(all P>0.05).The length of esophageal invasion was(3.5±1.1)cm and(3.7±1.1)cm,respectively in the transabdominal opening of the left diaphragm group and the thoracoabdominal combination group,and the difference was not statistically significant(t=-0.70,P=0.486).Compared with the thoracoabdominal combination group,the transabdominal opening of the left diaphragm group had less operative time,intraoperative bleeding,postoperative bedtime,chest tube extraction time and postoperative hospitalization days,and the differences were statistically significant(all P<0.05);the differences in the number of lymph nodes cleared,the number of positive lymph nodes,the number of thoracic lymph node dissection,and the number of positive thoracic lymph node were not statistically significant in the two groups(all P>0.05).The total incidence of postoperative complications in the transabdominal opening of the left diaphragm group and the thoracoabdominal combination group were

关 键 词：腺癌 食管胃接合处 SiewertⅡ型 手术入路 预后 

分 类 号：R735[医药卫生—肿瘤]