不同下纵隔淋巴结清扫顺序在Siewert Ⅱ型食管胃结合部腺癌中应用效果研究  

Application of different sequences of lower mediastinal lymph node dissection in Siewert type Ⅱ esophagogastric junction adenocarcinoma

作　　者：蔡永芹 王君菊 张敬敬 Cai Yongqin;Wang Junju;Zhang Jingjing(Blindness Prevention Office of Shandong First Medical University Affiliated Provincial Hospital,Jinan Shandong Province 250021,China;Department of Rehabilitation,Shandong Provincial Third Hospital,Jinan Shandong Province 250031,China;Department of Health and Cardiovascular,Shandong First Medical University Affiliated Provincial Hospital,Jinan Shandong Province 250021,China)

机构地区：[1]山东第一医科大学附属省立医院,济南250021 [2]山东省立第三医院康复科,济南250021 [3]山东第一医科大学附属省立医院保健心血管科,济南250021

出　　处：《中华普外科手术学杂志（电子版）》2024年第5期562-565,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的:对比研究不同下纵隔淋巴结清扫顺序在SiewertⅡ型食管胃结合部腺癌(AEG)手术中的应用效果及安全性。方法:选取2021年1月至2022年12月期间手术治疗的SiewertⅡ型AEG患者80例,采用随机数字表法均分为两组,每组患者各40例。两组患者均行腹腔镜下经腹食管裂孔(TH)入路下纵隔淋巴结清扫术。A组患者采用食管为中心按“腹侧→背侧→两侧”顺序进行清扫,B组采用“右侧→背侧→腹侧→左侧”顺序进行清扫。采用SPSS 20.0软件分析数据,围手术期指标、淋巴结清扫等采用(x±s)表示,行独立样本t检验;并发症等计数资料采用[例(%)]表示,行χ^(2)或Fisher或秩和检验;Kaplan-Meier法行术后生存分析,采用Log-Rank检验。P<0.05为差异有统计学意义。结果:所有患者均顺利完成手术,食管切缘均为阴性;B组患者下纵隔淋巴结清扫时间及清扫时出血优于A组(P<0.05);两组患者淋巴结清扫数目、术后恢复指标、并发症发生率及预后生存率比较,差异均无统计学意义(P>0.05)。结论:经腹TH入路两种下纵隔淋巴结清扫顺序均是安全可行的,具有近似的清扫效果及预后。以心下囊作为解剖标识,按“右侧→背侧→腹侧→左侧”顺序进行下纵隔淋巴结清扫利于提高手术安全可操作性,缩短下纵隔淋巴清扫时间,降低出血。Objective:To compare the efficacy and safety of different sequences of lower mediastinal lymph node dissection in Siewert type II esophagogastric junction adenocarcinoma(AEG).Methods:A total of 80 Siewert type Ⅱ AEG patients undergoing surgical treatment from January 2021 to December 2022 were selected and divided into two groups using random number table method,with 40 patients in each group.Both groups underwent laparoscopic transesophageal hiatus(TH)approach to lower mediastinal lymph node dissection.Patients in group A were cleaned in the order of"ventral→dorsal→bilateral"with the esophagus as the center,and group B was cleaned in the order of"right→dorsal→ventral→left".SPSS 20.0 software was used to analyze the data.Perioperative indicators and lymph node dissection were represented by independent sample t test.Complications and other statistical data were represented by[cases(%)],χ^(2) or Fisher or Rank Sum test;Survival analysis was performed by Kaplan-Meier method and Log-Rank test was used.P<0.05 was considered statistically significant.Results:All patients successfully completed the operation,esophagotomy margin was negative.The time and bleeding of lower mediastinal lymph node dissection in group B were better than those in group A(P<0.05).There was no significant difference in the number of lymph node dissection,postoperative recovery index,incidence of complications and prognosis survival between 2 groups(P>0.05).Conclusion:The two sequences of lower mediastinal lymph node dissection by transabdominal TH approach are safe and feasible,and have similar sweeping effect and prognosis.Using the subcardiac sac as the anatomic marker,lower mediastinal lymph node dissection in the sequence of"right→dorsal→ventral→left"was beneficial to improve surgical safety and maneuverability,shorten the time of lower mediastinal lymph dissection and reduce bleeding.

关 键 词：食管胃结合部腺癌 SiewertⅡ型 下纵隔淋巴结 淋巴结切除术 

分 类 号：R735[医药卫生—肿瘤]