中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2014年
5期
476-479
,共4页
食管胃交界腺癌,SiewertⅠ型%淋巴结清扫%腹腔镜%手术径路
食管胃交界腺癌,SiewertⅠ型%淋巴結清掃%腹腔鏡%手術徑路
식관위교계선암,SiewertⅠ형%림파결청소%복강경%수술경로
Adenocarcinoma of the esophagngastric junction,Siewert typeⅠ%Lymphadenectomy%Laparoscopy%Surgical approach
目的:探讨腹腔镜辅助手术治疗SiewertⅠ型食管胃结合部腺癌(AEJ)的安全性及临床效果。方法回顾性分析2008年3月至2013年3月间在福建省肿瘤医院接受腹腔镜辅助手术治疗的36例SiewertⅠ型AEJ患者的临床资料。手术入路采用不断肋弓的左侧胸腹单开切口,腹腔镜下行腹腔淋巴结清扫术,并经左胸行下纵隔淋巴结清扫术,消化道重建方式为食管-胃后壁端侧吻合。结果所有患者均手术成功,无一例患者住院期间死亡。手术时间(216.4±46.0) min,术中出血量(252.1±41.1) ml,淋巴结清扫数(30.7±3.2)枚,均为R0切除。术后并发症发生率为16.7%(6/36),均经保守治疗痊愈。淋巴结转移率为50.0%(18/36),其中第1、2、3、7、9、110和111组淋巴结转移率均超过10%。术后中位随访时间为25月,术后3年总体生存率为48.0%。结论腹腔镜辅助手术治疗SiewertⅠ型AEJ安全而有效。
目的:探討腹腔鏡輔助手術治療SiewertⅠ型食管胃結閤部腺癌(AEJ)的安全性及臨床效果。方法迴顧性分析2008年3月至2013年3月間在福建省腫瘤醫院接受腹腔鏡輔助手術治療的36例SiewertⅠ型AEJ患者的臨床資料。手術入路採用不斷肋弓的左側胸腹單開切口,腹腔鏡下行腹腔淋巴結清掃術,併經左胸行下縱隔淋巴結清掃術,消化道重建方式為食管-胃後壁耑側吻閤。結果所有患者均手術成功,無一例患者住院期間死亡。手術時間(216.4±46.0) min,術中齣血量(252.1±41.1) ml,淋巴結清掃數(30.7±3.2)枚,均為R0切除。術後併髮癥髮生率為16.7%(6/36),均經保守治療痊愈。淋巴結轉移率為50.0%(18/36),其中第1、2、3、7、9、110和111組淋巴結轉移率均超過10%。術後中位隨訪時間為25月,術後3年總體生存率為48.0%。結論腹腔鏡輔助手術治療SiewertⅠ型AEJ安全而有效。
목적:탐토복강경보조수술치료SiewertⅠ형식관위결합부선암(AEJ)적안전성급림상효과。방법회고성분석2008년3월지2013년3월간재복건성종류의원접수복강경보조수술치료적36례SiewertⅠ형AEJ환자적림상자료。수술입로채용불단륵궁적좌측흉복단개절구,복강경하행복강림파결청소술,병경좌흉행하종격림파결청소술,소화도중건방식위식관-위후벽단측문합。결과소유환자균수술성공,무일례환자주원기간사망。수술시간(216.4±46.0) min,술중출혈량(252.1±41.1) ml,림파결청소수(30.7±3.2)매,균위R0절제。술후병발증발생솔위16.7%(6/36),균경보수치료전유。림파결전이솔위50.0%(18/36),기중제1、2、3、7、9、110화111조림파결전이솔균초과10%。술후중위수방시간위25월,술후3년총체생존솔위48.0%。결론복강경보조수술치료SiewertⅠ형AEJ안전이유효。
Objective To evaluate the safety and efficacy of laparoscopy-assisted surgery for SiewertⅠadenocarcinoma of the esophagogastric junction(AEJ). Methods Clinical data of 36 patients who underwent left transthoracic dissection of lower mediastinal lymph node followed by laparoscopy D2 lymph node dissection for SiewertⅠAEJ in the Fujian Provincial Cancer Hospital between March 2008 and March 2013 were analyzed retrospectively. A left thoracic-abdominal single incision was used without transection of costal arch. Celiac lymph nodes dissection was performed laparoscopially followed by left transthoracic dissection of lower mediastinal lymph node. Digestive tract reconstruction was carried out by esophagus-gastric posterior wall end-to-side anastomosis. Results Laparoscopy-assisted surgery was successfully achieved in all the 36 patients and there were no in-hospital deaths. The mean operation time, blood loss and number of harvested lymph node were (216.4±46.0) min, (252.1±41.1) ml and 30.7±3.2 respectively. All the procedures were R0 resections. The complication rate was 16.7%(6/36). All the complications were managed by conservative treatment, and there were no re-operations. The lymphatic metastasis rate was 50.0%(18/36), and the lymph node groups with high metastatic rate (all> 10.0%) were groups 1, 2, 3, 7, 9, 110 and 111. The median follow-up was 25 months. The overall 3-year survival was 48.0%. Conclusion Laparoscopy-assisted surgery for SiewertⅠAEJ is safe and feasible.