Ⅱ、Ⅲ型食管胃结合部腺癌的临床分析

目的探讨Ⅱ、Ⅲ型食管胃结合部腺癌(AEG)的临床病理特点、手术治疗以及术后并发症情况。方法回顾性分析2008年1月至2010年7月实施开腹手术的112例Ⅱ、Ⅲ型AEG病例资料。其中Ⅱ型AEG 77例,Ⅲ型35例;72例行近端胃切除,40例行全胃切除。结果 112例Ⅱ、Ⅲ型AEG患者肿瘤分期较晚、淋巴转移率高。按肿瘤部位分为Ⅱ型AEG组和Ⅲ型AEG组,两组在手术方式选择上差异有统计学意义(P<0.05),分别有57例(74.0%)和15例(42.9%)行近端胃切除。按手术方式分为近端胃切除组和全胃切除组,两组在手术时间、术后并发症等方面的差异有统计学意义(P<0.05),手术时间分别为(275.76±27.02)min和(304.12±23.12)min;在术后并发症方面,近端胃切除组有15例(20.8%)患者出现烧心、返酸,有9例(12.5%)患有返流性食管炎;全胃切除组有15例(37.5%)每日进食大于5次。结论Ⅱ、Ⅲ型AEG目前主要经腹手术治疗,根据肿瘤的位置、大小选择行近端胃切除或全胃切除手术,两种术式术后都伴随有不同程度的并发症。

Clinical outcomes of surgical patients with types II and III adenocarcinoma of esophagogastric junction

Objective To investigate the clinical pathological characteristics,choice of surgical therapy and postoprative complications of patients with types Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction(AEG). Methods Clinical data of 112 patients with types Ⅱ and Ⅲ AEG who underwent intraperiteanal operations from January 2008 to July 2010 were reviewed.Amongst the patients,77 suffered from type Ⅱ AEG and 35 suffered from type Ⅲ AEG;72 underwent proximal gastrectomy and 40 underwent total gastrectomy.Results The patients with type Ⅱ and type Ⅲ AEG shared some common characteristics,such as advanced tumor TNM stage and lymphatic metastasis.There was a significant difference in choice of surgical approaches between the two groups of patients(P<0.05),with 57 type Ⅱ AEG patients(74.0%) and 15 type Ⅲ AEG patients(42.9%) undergoing proximal gastrectomy respectively.Operational time and incidence of postoperative complications differed between proximal gastrectomy and total gastrectomy(P<0.05).Total gastrectomy lasted longer((304.12±23.12) min) than proximal gastrectomy((275.76±27.02) min).Proximal gastrectomy provoked 20.8%(15 patients) heartburn and/or acid regurgitation and 12.5%(9 cases) reflux esophagitis.Fifteen patients(37.5%) with total gastrectomy had more than 5 meals a day.Conclusion Intraperiteanal operations are recommended for patients with types Ⅱ and Ⅲ AEG.The choice of proximal gastrectomy or total gastrectomy depends on the location and size of the tumor,both being followed with some complications.