解放军医学杂志2025，Vol.50Issue(10)：1270-1276,7.DOI:10.11855/j.issn.0577-7402.0424.2024.1114
单一体式经左胸+食管裂孔入路手术治疗Siewert Ⅱ型食管胃交界腺癌:一项回顾性队列研究
Single position left transthoracic and esophageal hiatal approach for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction:a retrospective cohort analysis
摘要
Abstract
Objective To explore the validity and feasibility of the left transthoracic and esophageal hiatal approach for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction under a single position.Methods The clinical data of 64 patients with Siewert type Ⅱ AEG(single position transthoracic approach group)treated with the left transthoracic and esophageal hiatal approach under a single position and 56 patients with the laparoscopic transesophageal slit approach(transabdominal approach group)in the Department of Thoracic Surgery,Huaihe Hospital of Henan University,from January 2017 to December 2018 were retrospectively analyzed.The clinical and pathological data,perioperative indicators(operation time,intraoperative blood loss,postoperative first ambulation time,postoperative first peristalsis time,postoperative drainage volume at 3 d,incidence of postoperative complications,postoperative hospital stay),postoperative complications(positive surgical margin,proximal esophageal resection margin,tumor diameter,total number of dissected lymph nodes,positive lymph node dissection rate,postoperative histopathology,and TNM staging of tumor pathology),and survival indicators(tumor recurrence and metastasis rate and survival at 1 month,3 months,6 months,1 year,3 years,5 years after surgery)were compared between the two groups.Kaplan-Meier method was used to analyze the postoperative survival rate of the two groups.Univariate analysis using χ2 test was employed to analyze factors influencing 5-year postoperative survival rate in Siewert type Ⅱ AEG patients.Results No significant difference was observed in clinical and pathological data,such as gender,age,American Society of Anesthesiologists(ASA)grade,tumor differentiation,pTNM stage,and tumor diameter between the two groups(P>0.05).No significant differences were noted in intraoperative blood loss,incidence of postoperative complications,and survival rates at 1 month,3 months,6 months,1 year,and 3 years after surgery between the two groups(P>0.05).The single position transthoracic approach group exhibited a higher postoperative drainage volume at 3 d compared to the transabdominal approach group(P<0.001),a shorter surgical time(P<0.001),a longer time to first mobilization,first intestinal peristalsis,and hospital stay after surgery(P<0.01),a longer proximal esophageal margin(P<0.001),a higher total number of lymph node dissections(P<0.001),and a higher positive lymph node dissection rate(P<0.05)than the transabdominal approach group.The 5-year recurrence-free survival rate of the single position transthoracic approach group was higher than that of the transabdominal approach group,with a statistically significant difference(P=0.013).The Kaplan-Meier survival curve showed no statistically significant difference in the 5-year overall survival rate between the two groups of patients after surgery(P=0.456).The results of univariate analysis indicated that there are significant relationships between tumor differentiation degree,pTNM stage,tumor diameter,and lymph node positivity rate with the 5-year postoperative survival rate in Siewert type Ⅱ AEG patients(P<0.05).Conclusion Siewert type Ⅱ AEG patients can be treated with the left transthoracic and esophageal hiatal approach under a single position,achieving the same effect as laparoscopic transesophageal slit approach,and it can be actively promoted as a complementary choice of operation in the clinic.关键词
单一体式经左胸+食管裂孔入路/腹腔镜下经食管裂孔入路/Siewert Ⅱ型食管胃交界腺癌/Orvil管形吻合Key words
single type left thoracic and esophageal hiatal approach/laparoscopic transesophageal slit approach/Siewert typeⅡ esophagogastric junction adenocarcinoma/orvil tubular anastomosis分类
医药卫生引用本文复制引用
韦海涛,王梦瑶,刘洋洋,张锋,胡宝利,张海峰,王晓龙,张冬红,李丽..单一体式经左胸+食管裂孔入路手术治疗Siewert Ⅱ型食管胃交界腺癌:一项回顾性队列研究[J].解放军医学杂志,2025,50(10):1270-1276,7.基金项目
This work was supported by the Science and Technology Research Project of Henan Provincial Science and Technology Department (242102310280,242102310184,242102310197,242102310100),and the Key Research and Development Project of Kaifeng,Henan Province(23ZDYF006)河南省科技厅科技攻关项目(242102310280,242102310184,242102310197,242102310100) （242102310280,242102310184,242102310197,242102310100）
河南省开封市重点研发专项(23ZDYF006) （23ZDYF006）
