食管胃结合部腺癌下纵隔淋巴结清扫范围与手术技巧  

Thinking about the extent and technique of lower mediastinal lymph nodes dissection for adenocarcinoma of esophagogastric junction

作　　者：曹钰尉 陈小龙[1] 杨昆[1] Cao Yuwei;Chen Xiaolong;Yang Kun(Gastric Cancer Center,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院胃癌中心,成都610041

出　　处：《中华胃肠外科杂志》2024年第9期909-913,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：四川省科技厅基金(2023YFS0060);四川大学华西医院学科卓越发展1·3·5工程项目(ZYJC21006)。

摘　　要：食管胃结合部腺癌的发病率逐渐增高,其外科手术步骤主要包括了根治性原发肿瘤切除、淋巴结清扫及消化道重建。由于食管胃结合部腺癌解剖部位的特殊性,即位于食管和胃交界区域,其淋巴结转移规律尚不明确,如何清扫区域淋巴结仍存争议,特别是下纵隔淋巴结清扫的范围还有待更多高质量证据予以论证。同时,由于下纵隔所处解剖部位的特殊性,在进行下纵隔淋巴结清扫时往往存在较大的手术难度。如何更安全有效地完成下纵隔淋巴结的清扫,是胃癌外科医师关注的要点。本文探讨了食管胃结合部腺癌患者下纵隔淋巴结清扫范围的相关进展、共识和争议,结合自身经验,总结了目前临床上较为成熟的下纵隔淋巴结清扫技巧,以期进一步提高食管胃结合部腺癌下纵隔淋巴结清扫的质量。The incidence of esophagogastric junction adenocarcinoma is increasing gradually.The surgical procedures mainly include radical resection of the primary tumor,lymph node dissection,and digestive tract reconstruction.Due to the special anatomical location of esophagogastric junction adenocarcinoma,the pattern of lymph node metastasis is not clear,and regional lymph nodes dissection especially in the lower mediastinum is still controversial,and awaits further high-quality evidence.Meanwhile,due to the special anatomical location of the lower mediastinum,it is often difficult to perform lower mediastinal lymph node dissection.How to complete the lower mediastinal lymph nodes dissection more safely and effectively is the key point for gastric cancer surgeons.In this paper,the progress,consensus,and controversy on the extent of lower mediastinal lymph nodes dissection in patients with esophagogastric junction adenocarcinoma were discussed.Based on our own experience,the current clinically techniques for lower mediastinal lymph nodes dissection were summarized to further improve the quality control of lower mediastinal lymph nodes dissection in patients with esophagogastric junction adenocarcinoma.

关 键 词：食管胃结合部腺癌 下纵隔淋巴结 淋巴结清扫 手术技巧 

分 类 号：R735[医药卫生—肿瘤]