摘要
目的探讨胃食管交界部癌(EGJ 癌)的最佳手术方式及 Siewert 分型下淋巴结转移规律。方法 26例 EGJ 癌患者中,12例采取腹胸两切口+腹腔胸腔两野淋巴结清扫术(两切口组),14例采用常规左开胸 EGJ 癌切除+肿大淋巴结摘除术(常规组)。结果 (1)两切口组和常规组平均清扫淋巴结组数(分别为7.3组和3.5组,P<0.01)及平均检出转移淋巴结组数(分别为1.9组和0.9组,P<0.05)差异均有统计学意义;平均切除腹腔淋巴结个数(分别为20.5个和13.3个,P<0.01)及胸腔淋巴结个数(分别为8个和4.9个,P<0.05)差异也有统计学意义;两切口组食管切缘距肿瘤5.8 cm 多于常规组的5.1 cm;两切口未损伤膈肌,减少了对呼吸和循环系统的影响。(2)Siewert 分型:Ⅰ型腹腔转移不严重,Ⅱ型胸腹腔双向转移,Ⅲ型腹腔转移为主,3个亚型的淋巴结转移有差别。结论腹胸两切口+腹腔胸腔两野淋巴结清扫术有助于提高 EGJ 癌手术的根治性,有助于研究 EGJ癌的转移规律。
Objective To explore the best operation pattern of esophagogastric junction （EGJ） cancer and the regularity of lymph node metastasis in EGJ cancer according to Siewert typing. Methods Twenty-six patients with EGJ cancer received esophagogastrectomy by thoracic-abdominal double incision and two-field lymphadenectomy （12 cases） or by traditional left postero-lateral thoracotomy and lymph node sampling （ 14 cases）. The outcomes were analyzed with SPSS 10.0 software Results （ 1 ） The number of lymph node dissection group of the thoracic-abdominal double incision group was 7.3 lymph node groups, significantly more than that of the traditional left postero-lateral thoracotomy group （ 3.5 lymph node group, P 〈0. 001 ）. The number of proved metastatic lymph nodes of the thoracic-abdominal double incision group was 1.9 groups, significantly higher than that of the traditional left postero-lateral thoracotomy group （ 0.9 group, P=0. 013）. The distance between the esophageal incisal edge and the tumor was 5.8 cm in the thoracic-abdominal double incision, longer than that in the traditional left thoracotomy group （5.1 cm）. The diaphragm was not damaged in the double-incision group, thus the influence to respiration and circulation was decreased. （2） The abdominal metastasis of Siewert type Ⅰ cancer was not severe, the cancer of type Ⅱ might metastasize to abdominal or thoracic cavity, and the main metastatic site of type Ⅲ cancer was abdominal cavity. Conclusion Thoracic-abdominal double incision and two-field lymphadenectomy helps increase the radical resection rate of EGJ cancer and study the regularity of lymph node metastasis.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2007年第21期1478-1481,共4页
National Medical Journal of China
关键词
胃肿瘤
食管肿瘤
外科手术
淋巴结切除术
Stomach neoplasms
Esophageal neoplasms
Surgery procedures, operative
Lymth node excision
