张 炎,庞 玮,刘 刚,张朝军.全腔镜下经腹膈入路全胃切除治疗Siewert Ⅱ型食管胃交界部腺癌的围手术期疗效分析[J].转化医学杂志,2019,8(3):157-161
全腔镜下经腹膈入路全胃切除治疗Siewert Ⅱ型食管胃交界部腺癌的围手术期疗效分析
Treatment and efficacy analysis of totally laparoscopic transdiaphragm approach for Siewert Ⅱ adenocarcinoma of esophagogastric junction resection
  
DOI:
中文关键词:  食管胃交界部腺癌  Siewert Ⅱ型  腹腔镜全胃切除术
英文关键词:Adenocarcinoma of esophagogastric junction (AEGJ)  Siewert type Ⅱ  Laparoscopic total gastrectomy
基金项目:原海军总医院创新培育基金(CXPY201610)
作者单位
张 炎 中国人民解放军总医院第六医学中心普通外科 
庞 玮 中国人民解放军总医院第六医学中心普通外科 
刘 刚 中国人民解放军总医院第六医学中心普通外科 
张朝军 中国人民解放军总医院第六医学中心普通外科 
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中文摘要:
      目的 探讨全腹腔镜下经腹切开膈肌扩大食管裂孔入路的根治性全胃切除治疗Siewert Ⅱ型食管胃交界部腺癌的围手术期疗效。方法 回顾性分析2017年4月—2017年12月解放军总医院第六医学中心普通外科开展的全腹腔镜下经腹膈肌入路行D2淋巴结清扫和消化道重建的10例Siewert Ⅱ型食管胃交界部腺癌患者的围手术期资料。10例均行全胃切除,并行食管-空肠消化道重建,其中8例使用圆型吻合器吻合,2例使用直线吻合器吻合。结果 10例患者均顺利完成手术,平均手术时间250(230-290)min,消化道重建时间52(40-70)min,术中出血量160(80-350)mL,无中转开腹。术后切缘全部为阴性,平均肿瘤直径5.4(3.5-7.1)cm,侵及食管长度2.0(1.5-4.2)cm,平均淋巴结清扫个数32.5(26-40)个。术后1例患者出现吻合口瘘及肺部感染,经治疗后痊愈出院。术后平均随访时间为6个月,无明显食管反流、进食困难等并发症发生。结论 对SiewertⅡ型食管胃交界部腺癌行全腹腔镜下经腹膈肌入路淋巴结清扫和食管-空肠消化道重建可行并可以达到根治性手术的切除要求,但手术方式较新,远期疗效需要更大规模的研究证实。
英文摘要:
      Objective We aim to evaluate the perioperative efficacy of application of an intra-abdominal diaphragmic incision (IADI) technique to enlarge esophageal-hiatus in totally laparoscopic total gastrectomy (TLTG) for lymph node dissection and esophagojejunostomy (EJ) in patients with Siewert Ⅱ adenocarcinoma of esophagogastric junction (AEGJ). Methods Ten individuals with Siewert Ⅱ AEGJ that underwent TLTG with D2 lymph node dissection and EJ via IADI approach were recruited between April 2017 and December 2017 retrospectively. Among them, eight cases were anastomosed through circular stapler and two cases through linear stapler. Results The operations of the 10 patients were completed successfully. The average operative time was 250 (230-290) minutes, the time of digestive tract reconstruction was 52 (40-70) minutes and intraoperative bleeding was 160 (80-350)mL. No conversions to open surgery occurred. The margins of resection were free of tumor in the specimens of all patients, the average diameter of tumors was 5.4 (3.5-7.1) centimeters, the average length of the esophagus invaded was 2.0 (1.5-4.2) centimeters and the average number of the lymph nodes dissected was 32.5 (26-40). Post-operative EJ leakage with pulmonary infection was observed in one patient, which was managed non-operatively and the patient was cured and discharged. No complications of esophageal reflux and difficulty in eating were observed during a mean follow-up time of 6 months. Conclusion The method of lymph node dissection and EJ in TLTG by using IADI approach is feasible and safe for patients with Siewert Ⅱ AEGJ, which can achieve the request of radical surgery excision. However, the long-term efficacy of this new method needs to be confirmed by larger studies.
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