摘要
食管胃交界腺癌(AEG)指发生于食管远端和胃贲门区域的腺癌,其发生率明显上升。由于两种腺癌发生部位接近、生物学行为相似、预后均较差,多数学者认为AEG是一独特的临床病理类型。目前对AEG分型采用最广泛的是S iewert分型方法;在分期方面尚无单独的分期研究,一般根据病灶主体所在部位,按现行TNM分期系统,Ⅰ型和Ⅱ、Ⅲ型分别按食管癌和胃癌分期。手术切除是AEG最主要的治疗手段,在保证手术安全的前提下应力争达到R0切除,切缘应距肿瘤边缘5 cm。常规手术径路有经胸、经腹、胸腹联合3种,一般Ⅰ型者多采用经胸途径,Ⅱ、Ⅲ型者多采用经腹途径。对于T2期以上者应按D2标准进行淋巴结清扫,扩大切除(联合脾或胰腺体尾切除)仅限于特定的较晚期病例。早期病例(T1b)可行D1手术。有关AEG综合治疗的研究很少,对病期较晚(T2分期以上)者可以选择ECF为主的新辅助化疗或辅助化疗、化放疗。
Adenocareinoma of esophagogastric junction（AEG） is an adenocarcinoma that arises in the vicinity of the esophagogastric junction, including tumors in the distal esophagus and in the proximal stomach and its incidence is rapidly increasing. Due to differential biological features and poor prognosis, AEG has historically been considered a unique clinical entity. Siewert＇s Clasfication of AEG has been increasingly accepted over the world and the TNM classification system of UICC is commonly used for staging. Surgery is the primary treatment for AEG. R0 resection is one of the major prognostic factors in AEG. Thus, complete removal of the primary tumor with adequate margins（5cm） and its lymphatic drainage is a wide agreed upon surgical principle for the management of AEG. There are mainly three surgical approaches for the operation, including transabdominal approach, trans-left thoracic approach and transthoracoabdominal approach. As regard to type Ⅰ , trans-left thoracic approach should be selected, whereas transabdominal approach should be performed for patients with type Ⅱ and type Ⅲ. Total gastrectomy combined with D2 dissection should be recommended for patients of T2 or higher tumors. Routine or prophylactic splenectomy is not required; splenectomy is only acceptable when the spleen or the hilum is involved. For early AEG（Tlb） patients, gastric resection accompanies the regional lymphadenectomy （D1） can be choiced. Muhimodality treatments including radiotherapy, chemotherapy with ECF regimen or its modifications is recommended for advanced（T2 or higher tumors） AEG.
出处
《临床肿瘤学杂志》
CAS
2010年第7期667-669,共3页
Chinese Clinical Oncology
关键词
食管胃交界腺癌
外科治疗
分型
胃肿瘤
Adenocarcinoma of esophagogastric junction
Surgical approach
Classification
Stomach neoplasma
