SiewertⅡ型食管胃交界部腺癌不同手术入路下的术式探讨及淋巴结转移规律分析

发布时间：2019-04-12 16:58

【摘要】：目的探讨siewert II型食管胃交界部腺癌的不同手术入路下治疗效果及淋巴结转移规律。方法回顾性分析2005-2012年辽宁省肿瘤医院胸外科及胃外科收治的Siewert II型食管胃交界部腺癌患者的临床资料,对不同手术入路及术式下的患者基线资料、手术安全性、术后并发症发生率、肿瘤根治程度、术中淋巴结清扫及生存情况进行比较,同时分析了II型食管胃交界部腺癌淋巴结转移特点。结果共筛选出126例Siewert II型AEG患者,经胸入路(经胸组)86例、经腹入路(经腹组)40例。其中经腹近端胃切除32例,经腹全胃切除8例。安全性方面:1.手术时间经胸组(108±44.29min)较经腹(近端胃)组(169±52.37min)和经腹(全胃)组(202±37.19min)用时更短(p0.001)。2.住院时间经胸组(17±8天)较经腹(近端胃)组(18±6天)、经腹(全胃)组(23±4天)经胸组较经腹(全胃)组住院时间更短(p0.05)。3.术中出血量、术后肺部并发症、循环系统并发症、吻合口瘘及术后30天内死亡率三组比较未出现统计学差异。根治度及预后方面:1.经胸组食管切除长度(4.80±1.18cm)较经腹(近端胃)组(2.87±1.01cm)及(全胃)组(2.52±0.84cm)更长(p0.0001)2.经腹组食管切缘阳性率高于经胸组(p0.0001)。3.经腹组淋巴结清扫个数多于经胸组(p=0.012)。经腹(近端胃)组(12.62±5.81枚)清扫数量少于全胃组(18.25±5.52)(p=0.018)。两组在腹贲门旁、胃左动脉旁淋巴结清扫率及清扫度上无统计学差异(p0.05)。经胸入路淋巴结清扫重点为贲门旁、胃左动脉旁、食管旁及膈上、胃小弯及隆突下淋巴结。经腹入路淋巴结清扫重点为贲门旁、胃小弯、胃左动脉旁、肝总动脉旁、腹腔干、胃大弯、幽门上下淋巴结。4.经胸组中位生存期39个月,5年生存率37.5%,经腹组中位生存期53个月,5年生存率为33.6%。两组差别统计学上未见差异(p=0.353)。淋巴结转移特点:II型AEG淋巴结以贲门旁(38.9%)、胃左旁(41.3%)、胃小弯旁(28.9%)转移最为常见。食管及膈上(18.8%)。结论Siewert II型AEG不同入路下手术生存期及安全性未见明显差异。单一入路下手术根治度有限。对于术前评估肿瘤体积较大,多站淋巴结转移的病例,经胸腹双入路可能在兼顾肿瘤切除及淋巴结清扫上更具优势。
[Abstract]:Objective to investigate the therapeutic effect and lymph node metastasis of siewert II-type adenocarcinomas at the junction of esophagus and stomach under different surgical approaches. Methods from 2005 to 2012, the clinical data of patients with Siewert II-type adenocarcinomas at the junction of esophagus and stomach treated by thoracic surgery and gastrosurgery in Liaoning Cancer Hospital were retrospectively analyzed. The baseline data and safety of the patients under different surgical approaches and operations were analyzed. The incidence of postoperative complications, the degree of radical resection, lymph node dissection and survival during operation were compared, and the characteristics of lymph node metastasis in adenocarcinomas at the junction of esophagus and stomach of type II were analyzed. Results A total of 126 cases of Siewert type II AEG were selected, 86 cases were transthoracic approach (transthoracic group) and 40 cases were transabdominal approach (transabdominal group). Among them, 32 cases underwent proximal gastrectomy and 8 cases underwent total gastrectomy. Safety aspects: 1. The operation time in the thoracic group (108 卤44.29min) was shorter than that in the abdominal (proximal stomach) group (52.37 min) and the abdominal (whole stomach) group (202 卤37.19 min) (p0.001). The hospitalization time of the thoracic group (17 卤8 days) was shorter than that of the abdominal (proximal stomach) group (18 卤6 days), and that of the transabdominal (whole stomach) group (23 卤4 days) was shorter than that of the transabdominal (whole stomach) group (p0.05). There was no significant difference in intraoperative bleeding, postoperative pulmonary complications, circulatory complications, anastomotic fistula and mortality within 30 days after operation. Degree of radical treatment and prognosis: 1. The length of esophagectomy in the thoracic group (4.80 卤1.18cm) was longer than that in the abdominal (proximal stomach) group (2.87 卤1.01cm) and (total stomach) group (2.52 卤0.84 cm) (p 0.0001) 2. The positive rate of esophageal incisal margin in abdominal group was higher than that in transthoracic group (p0.0001). The number of lymph node dissection in the abdominal group was more than that in the transthoracic group (p < 0. 012). The number of abdominal (proximal stomach) group (12.62 卤5.81) was less than that of whole stomach group (18.25 卤5.52) (p < 0. 018). There was no significant difference in lymph node clearance rate and clearance degree between the two groups at the side of abdominal cardia and left gastric artery (p0.05). Transthoracic lymph node dissection included pericardial, left gastric artery, esophageal and supra-phrenic lymph nodes, small curvature of the stomach and subcarinal lymph nodes. The main points of lymph node dissection through abdominal approach were paracardia, small curvature of stomach, left gastric artery, common hepatic artery, celiac trunk, great curvature of stomach, suprapyloric lymph node. 4. The median survival time was 39 months, the 5-year survival rate was 37.5% in the thoracic group, and the 5-year survival rate was 33.6% in the abdominal group and 53 months in the abdominal group. There was no statistical difference between the two groups (p = 0.353). The characteristics of lymph node metastasis were as follows: paracardial lymph node (38.9%), left side of stomach (41.3%), paracentesis (28.9%) of type II AEG lymph node. Esophageal and supraphrenic (18.8%). Conclusion there is no significant difference in the survival time and safety of Siewert type II AEG under different approaches. The degree of radical operation under single approach is limited. For patients with large tumor size and multi-station lymph node metastasis before operation, transthoracic and abdominal double approach may be more advantageous in both tumor resection and lymph node dissection.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735

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