中国综合临床
中國綜閤臨床
중국종합림상
Clinical Medicine of China
2015年
9期
840-842
,共3页
李鹏程%李林卿%杨小磊%朱金航
李鵬程%李林卿%楊小磊%硃金航
리붕정%리림경%양소뢰%주금항
食管胃结合部腺癌%手术入路%Siewert分型
食管胃結閤部腺癌%手術入路%Siewert分型
식관위결합부선암%수술입로%Siewert분형
Gastroesophageal junction adenocarcinoma%Operation approach%Siewert classification
目的 探讨不同手术入路治疗SiewertⅡ、Ⅲ型食管胃结合部腺癌的效果.方法 选择SiewertⅡ、Ⅲ型食管胃结合部腺癌患者共148例进行回顾性研究,包括经胸入路组58例和经腹入路组90例.对手术结果进行比较;随访2年,比较患者的生存情况.结果 经胸入路组与经腹入路组患者手术时间[(329.5±84.3)、(202.4±84.5)min,t=15.431、P＜0.001)、切缘残端阳性率(8.62％与1.11％,x2=5.763、P=0.012)、胸腔积液(13.79％与2.22％,x2=10.462、P＜0.001)、肺部感染发生率(15.52％与1.11％,x2=12.574、P＜0.001)、淋巴结清扫数[(16.7±4.3)、(22.6±5.5)个,t=6.321、P=0.004)比较差异均有统计学意义.两组患者术中出血量、肿瘤直径、吻合口漏或出血的发生率、住院时间比较差异均无统计学意义(P均＞0.05).经胸入路组1年生存率73.24％,2年生存率为53.43％;经腹入路组1年生存率为78.42％,2年生存率为57.51％,两组比较差异无统计学意义(P=0.453、P=0.311).结论 SiewertⅡ、Ⅲ型食管胃结合部腺癌患者经腹入路的手术方式明显优于经胸入路,可更好地进行腹部淋巴结的清扫,不破坏胸腔的完整性,避免相关的并发症发生.
目的 探討不同手術入路治療SiewertⅡ、Ⅲ型食管胃結閤部腺癌的效果.方法 選擇SiewertⅡ、Ⅲ型食管胃結閤部腺癌患者共148例進行迴顧性研究,包括經胸入路組58例和經腹入路組90例.對手術結果進行比較;隨訪2年,比較患者的生存情況.結果 經胸入路組與經腹入路組患者手術時間[(329.5±84.3)、(202.4±84.5)min,t=15.431、P＜0.001)、切緣殘耑暘性率(8.62％與1.11％,x2=5.763、P=0.012)、胸腔積液(13.79％與2.22％,x2=10.462、P＜0.001)、肺部感染髮生率(15.52％與1.11％,x2=12.574、P＜0.001)、淋巴結清掃數[(16.7±4.3)、(22.6±5.5)箇,t=6.321、P=0.004)比較差異均有統計學意義.兩組患者術中齣血量、腫瘤直徑、吻閤口漏或齣血的髮生率、住院時間比較差異均無統計學意義(P均＞0.05).經胸入路組1年生存率73.24％,2年生存率為53.43％;經腹入路組1年生存率為78.42％,2年生存率為57.51％,兩組比較差異無統計學意義(P=0.453、P=0.311).結論 SiewertⅡ、Ⅲ型食管胃結閤部腺癌患者經腹入路的手術方式明顯優于經胸入路,可更好地進行腹部淋巴結的清掃,不破壞胸腔的完整性,避免相關的併髮癥髮生.
목적 탐토불동수술입로치료SiewertⅡ、Ⅲ형식관위결합부선암적효과.방법 선택SiewertⅡ、Ⅲ형식관위결합부선암환자공148례진행회고성연구,포괄경흉입로조58례화경복입로조90례.대수술결과진행비교;수방2년,비교환자적생존정황.결과 경흉입로조여경복입로조환자수술시간[(329.5±84.3)、(202.4±84.5)min,t=15.431、P＜0.001)、절연잔단양성솔(8.62％여1.11％,x2=5.763、P=0.012)、흉강적액(13.79％여2.22％,x2=10.462、P＜0.001)、폐부감염발생솔(15.52％여1.11％,x2=12.574、P＜0.001)、림파결청소수[(16.7±4.3)、(22.6±5.5)개,t=6.321、P=0.004)비교차이균유통계학의의.량조환자술중출혈량、종류직경、문합구루혹출혈적발생솔、주원시간비교차이균무통계학의의(P균＞0.05).경흉입로조1년생존솔73.24％,2년생존솔위53.43％;경복입로조1년생존솔위78.42％,2년생존솔위57.51％,량조비교차이무통계학의의(P=0.453、P=0.311).결론 SiewertⅡ、Ⅲ형식관위결합부선암환자경복입로적수술방식명현우우경흉입로,가경호지진행복부림파결적청소,불파배흉강적완정성,피면상관적병발증발생.
Objective To investigate the surgical approach of Siewert Ⅱ and Ⅲ gastroesophageal junction adenocarcinoma.Methods A total of 148 cases with Siewert Ⅱ,Ⅲ type patients were prospectively studied.The patients were divided into two groups,including transthoracic approach group (58 cases) and transabdominal approach group(90 cases).The results of surgery were compared.Patients were followed up for 2 years and survival rate were compared.Results In transthoracic approach group and transabdominal approach group,operative time ((329.5 ± 84.3) min vs.(202.4± 84.5) min,t =15.431,P ＜ 0.001),the positive rate margin stump (8.62％ vs.1.11％,x2 =5.763,P =0.012),pleural effusion (13.79％ vs.2.22％,x2 =10.462,P ＜0.001) and pulmonary infection rate (15.52％ vs 1.11％,x2 =12.574,P＜ 0.001) were significantly higher than transabdominal approach group,and number of lymph node dissection ((16.7 ± 4.3) vs.(22.6± 5.5),t =6.321,P =0.004) was significantly less than transabdominal approach group.In incidence of blood loss,tumor diameter,anastomotic leakage (or bleeding) and discharge time,there was no significant difference (P ＞0.05).One-year survival rate of transthoracic approach group was 73.24％,and 2-year survival rate was 53.43％.Oneyear survival rate of transabdominal approach group was 78.42％,and 2-year survival rate was 57.51％.Survival rate of two groups showed no significant difference (P =0.453,0.311).Conclusion Transabdominal surgical approach in Siewert Ⅱ,Ⅲ patients is better than transthoracic approach,can better carry out abdominal lymph node dissection,does not destroy the integrity of the chest,and avoid the occurrence of related complications.
