CAJ | 학술논문

目的探讨不同手术径路治疗进展期SiewertⅡ型食管胃结合部腺癌(食管浸润≤3 cm)的优缺点及疗效。方法对251例SiewertⅡ型食管胃结合部腺癌患者施行D2或D2+的全胃切除术，其中经腹部正中切口组（the transabdominal approach，TA组）128例，经左胸腹联合切口组(the left thoracoabdominal approach，LTA组)123例，对两组的手术时间、术中出血量、远段食管切除长度、上切缘癌残留率、平均淋巴结清扫数目、围术期并发症发生率、病死率以及术后3、5年总体生存率进行对比分析。结果 TA组和LTA组的术后3、5年总体生存率分别为62.5％、39.0％和54.9％、31.9％，两组相比差异均无统计学意义(P＞0.05)。LTA组的远段食管切除长度较TA组稍长(5.6±1.1) cm比（5.4±1.1）cm，但两组手术的切缘癌残留率为1.6％（LTA组）比3.1％（TA组），差异均无统计学意义（均P＞0.05）。TA组手术平均淋巴结清扫数目(23.4±8.7)枚，与LTA组的(23.7±8.4)枚比较差异无统计学意义(P＞0.05)。TA组在手术时间(227±24)min、术中出血量(270±78) ml及围术期并发症发生率(13.3％)和病死率(1.6％)方面均明显优于LTA组[(261±32) min、（342±59）ml，26.8％和6.5％]，差异均具有统计学意义（均P＜0.05）。结论对SiewertⅡ型食管胃结合部腺癌（食管浸润≤3 cm）患者，经腹部正中切口行全胃切除术（D2或D2+淋巴结切除术）可达到良好的根治目的，且围术期并发症的发生率和病死率均较低。
목적 탐토불동수술경로치료진전기SiewertⅡ형식관위결합부선암(식관침윤≤3 cm)적우결점급료효。방법 대251례SiewertⅡ형식관위결합부선암환자시행D2혹D2+적전위절제술，기중경복부정중절구조（the transabdominal approach，TA조）128례，경좌흉복연합절구조(the left thoracoabdominal approach，LTA조)123례，대량조적수술시간、술중출혈량、원단식관절제장도、상절연암잔류솔、평균림파결청소수목、위술기병발증발생솔、병사솔이급술후3、5년총체생존솔진행대비분석。결과 TA조화LTA조적술후3、5년총체생존솔분별위62.5％、39.0％화54.9％、31.9％，량조상비차이균무통계학의의(P＞0.05)。LTA조적원단식관절제장도교TA조초장(5.6±1.1) cm비（5.4±1.1）cm，단량조수술적절연암잔류솔위1.6％（LTA조）비3.1％（TA조），차이균무통계학의의（균P＞0.05）。TA조수술평균림파결청소수목(23.4±8.7)매，여LTA조적(23.7±8.4)매비교차이무통계학의의(P＞0.05)。TA조재수술시간(227±24)min、술중출혈량(270±78) ml급위술기병발증발생솔(13.3％)화병사솔(1.6％)방면균명현우우LTA조[(261±32) min、（342±59）ml，26.8％화6.5％]，차이균구유통계학의의（균P＜0.05）。결론 대SiewertⅡ형식관위결합부선암（식관침윤≤3 cm）환자，경복부정중절구행전위절제술（D2혹D2+림파결절제술）가체도량호적근치목적，차위술기병발증적발생솔화병사솔균교저。
Objective To compare the effects of different surgical approaches on Siewert Ⅱ (esophageal invasion ≤3 cm) adenocarcinoma of esophagogastric junction. Methods This retrospective study included 251 cases of Siewert Ⅱ adenocarcinoma of esophagogastric junction undergoing D2 or D2 + total gastrectomy by transabdominal approach ( TA group, 128 cases) or left thoracoabdominal approach ( LTA group, 123 cases). Operation time,blood loss, extent of esophageal resection, number of lymph nodes dissected,morbidity, mortality and the survival rate were a analyzed between the two groups. Results The 3,5-year overall survival rates were 62. 5％, 39.0％ ( TA group) and 54. 9％, 31.9％ ( LTA group),respectively (P ＞ 0. 05). Length of esophageal resection in the LTA group were slightly longer than that in the TA group (5. 6 ± 1.1) cm vs. (5.4 ± 1.1 ) cm (P ＜0. 05), the positive surgical margin between two groups were not statistically different[1.6％ ( LTA group) vs. 3. 1％ ( TA group), ( P ＞ 0. 05 )]. The mean number of removed lymph node were not significantly different between two groups[23.4 ± 8.7 ( TA group) vs. 23.7 ± 8.4 ( LTA group)], ( P ＞ 0. 05 ). The operation time (227 ± 24) min, blood loss (270 ± 78)ml, and perioperative morbidity( 13.3％ ) and mortality( 1.6％ ) in TA group was significantly better than the LTA group[(261 ±32) min, (342 ±59)ml, 26.8％, 6.5％](P＜0.05). Conclusions For Siewert Ⅱ adenocarcinoma at esophagogastric junction (esophageal invasion ≤3 cm) ,total gastrectomy with D2 or D2 + lymph node dissection through the transabdominal approach could achieve curative purposes, with a low morbidity and mortality rate.