【摘要】 目的 探讨SiewertⅡ、Ⅲ型食管胃结合部腺癌(AEG)经胸与经腹两种手术入路的治疗效果的差异,为SiewertⅡ、Ⅲ型AEG患者选择理想的手术入路提供理论及临床依据。方法 回顾性分析2004~2007年行手术治疗的466例SiewertⅡ、Ⅲ型AEG患者的临床资料,其中经胸手术组298例,经腹手术组行168例。统计分析两种手术径路的手术时间、术中出血量、平均住院时间、上、下切缘残端阳性率、平均清扫淋巴结数、各组淋巴结清扫数目及各组淋巴结转移率、术后并发症发生率、以及术后患者1年、3年、5年生存率。采用χ~2检验、t检验,Kaplarr-Meier法绘制生存曲线,Logrank检验分析生存情况。结果经胸组与经腹组在术中出血量、住院时间上两组差异无统计学意义(P>0.05)。经胸组手术时间长,平均清扫淋巴结数目少(P<0.05)。经腹组下切缘残端阳性率较低(P<0.05)。上切缘残端阳性率两组差异无统计学意义(P>0.05)。术后并发症发生率经腹组较经胸组低(P<0.05)。1~3组及5~8组淋巴结转移数经腹组较经胸组高(P<0.05)。其余各组淋巴结转移数,两组比较差异无统计学意义(P>0.05)。随访时间截至2012年12月,两组1年、3年、5年生存率差异无统计学意义(P>0.05)。结论 对于SiewertⅡ、Ⅲ型AEG患者,尤其是年龄较大、身体基础情况差的患者,为减少术后并发症,提高患者术后生活质量,经腹入路手术更为合理。经腹手术入路优于经胸手术入路的治疗效果。更多还原

【Abstract】 Objective To investigate the therapeutic effects of transthoracic approach vs. transabdominal approach for the patients with Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction(AEG),and choose an ideal surgical approach for patients with Siewert Type Ⅱ and Ⅲ AEG.Methods The clinical data of 466 patients with Siewert type Ⅱ and Ⅲ AEG who had undergone surgery were retrospectively analyzed during 2004 to 2007,including 298 cases of transthoracic approach,and 168 cases of transabdominal approach.Operation time,blood loss,average hospital stay, positive rate of the upper and lower cut edge of the stump,average number of lymph node dissection, number of lymph node dissection in each group,metastasis rate of lymph node in each group,incidence of postoperative complications,1-,3-and 5-year survival rate after the surgery were statistically analyzed.Results The difference in operation time and blood loss had no statistically significant difference between two groups(P>0.05).The transthoracic approach group took a long time in surgery and its average number of lymph node dissection was less(P<0.05).The transabdominal approach group had the lower positive rate of the lower cut edge of the stump(P<0.05),but the difference in the positive rate of the upper cut edge of the stump was not statistically significant(P>0.05). As compared with the transthoracic approach group,the transabdominal approach group had a higher lymph node metastasis rate in No.1-3 and No.5-8(P<0.05).There was no significant difference in the overall 1-,3-,and 5-year survival rate between transthoracic approach group and transabdominal approach group(P>0.05).Conclusion In order to reduce complications and improve the quality of life of patients,the transabdominal approach surgery is more reasonable for AEG Ⅱ,Ⅲ patients,especially for the older patients with poor physical basis.Transabdominal approach has an advantage in terms of therapeutic effects than transthoracic approach.更多还原