腹胸两切口加两野淋巴结清扫治疗胃食管交界部癌的临床研究

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5．8cm多于常规组的5．1cm;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。

A clinical study of thoracic-abdominal double-incision and two-field lymphadenectomy in treatment of esophagogastric junction cancer

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.