不同分型食管胃交界部腺癌的淋巴结转移规律及手术方式的选择研究

目的：探究不同分型食管癌交界部腺癌（AEG）患者术后淋巴结转移规律以及手术方式的选择。方法：以我院2007年4月至2013年6月收治的158例食管癌胃交界部腺癌患者作为研究对象,所有患者均行经上腹、左胸入路淋巴清扫术,术后对各分型淋巴结转移的规律进行比较分析,并对手术方式的选择予以探讨。结果：158例患者术中共清扫淋巴结2449枚,平均每例清扫15.5枚,其中证实有105例患者伴有淋巴结转移,阳性淋巴结总数转移度711枚,转移度为29.0%,其中胸下段食管旁及下纵隔淋巴结转移以SiewertⅠ型患者为主。AEG患者淋巴结转移与否在肿瘤大小和病理分期方面具有显著差异性（P〈0.01）,具有统计学意义。结论：AEG患者淋巴结转移与肿瘤大小和病理分期有着密切的关系,根据Siewert分型,Ⅰ型、Ⅱ型的AEG患者均可选择经上腹左胸两切口,而Ⅲ型AEG患者则可选择单一经腹切口进行手术。

Transfer Rule of Lymph Node Metastasis in Different Types of Adenocarcinoma of Boundary Part of Esophageal and Surgical Approach

Objective： To explore the transfer rule of lymph node metastasis in different types of adenocarcinoma of boundary part of esophageal and stomach（ AEG） and surgical approach. Method： Selected 158cases of esophageal stomach border of adenocarcinoma patients treated from April 2007 to June 2013 as the research objects,all the patients were taken surgery of lymph node cleaning through the abdomen,left thoracic,and then comparative analyzed transfer rule of lymph node metastasis in different types of adenocarcinoma of boundary part of esophageal gastric,and discussed the surgical approach of adenocarcinoma of the esophagogastric junction. Result： 2449 trunk of lymph nodes were cleaned in 158 patients,the average was15.5 trunk of one case,which confirmed 105 cases of patients with lymph node metastasis,and 711 trunks of positive lymph nodes metastasis degree,transfer degree was 29.0%,among them under the lower thoracic segment esophageal branch into mediastinal lymph node metastasis in Siewert Ⅰ type patients. AEG patients with lymph node metastasis or not has significant differences in tumor size and pathology staging（ P〈0.01）,There was statistical significance. Conclusion： The transfer rule of lymph node metastasis in patients of AEG have close relations with the tumor size and pathology staging,according to Siewert parting,AEG patients with Ⅱ type Ⅰand of can choose the approach of abdomen and left breast,while AEG patients with type Ⅲof can choose single abdominal incision surgery.