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目的探讨腹腔镜联合左胸小切口治疗SiewertⅡ/Ⅲ型食管胃结合部腺癌(AEG)在减少手术创伤同时安全、有效的充分切除肿瘤及淋巴结清扫的可行性。方法回顾分析2014年10月—2015年12月于林州市人民医院手术治疗的SiewertⅡ/Ⅲ型食管胃结合部腺癌患者193例的临床资料,其中58例行腹腔镜联合左胸小切口手术,135例行单一左胸切口手术治疗,分析2组患者手术时间、术中出血量、术后胸腔引流总量、胸腔引流带管时间、纵隔及腹腔淋巴结清扫数目,并进行统计学处理。结果腔镜组手术时间长于单左胸组,差异有统计学意义(P<0.05),而术中出血量、术后胸腔总引流量、术后住院时间、腹腔淋巴结清扫数目、VAS疼痛评分等方面,腔镜组均具有优势,差异有统计学意义(P<0.05);2组术后胸腔引流管引流时间、纵隔淋巴结清扫数目差异无统计学意义(P>0.05)。2组患者术后并发症的发生率均较低,腔镜组二次剖胸手术止血1例,2组各有1例患者术后发生轻度食管胃吻合口瘘,腔镜组发生肺部感染1例,单左胸组发生肺部感染5例,各组均无胸腹腔内、切口感染,无围手术期死亡。结论腹腔镜联合左胸小切口用于SiewertⅡ/Ⅲ型AEG的手术治疗具有创伤小、恢复快、切口疼痛轻、腹腔淋巴结清扫彻底、胸内食管胃吻合确切、瘤上切缘食管充分的优点,值得临床推广。
Objective To investigate the feasibility of laparoscopic combined with left small incision for the treatment of Siewert Ⅱ / Ⅲ esophagogastric junctional adenocarcinoma (AEG) in reducing the surgical trauma and safely and effectively removing the tumor and lymph nodes. Methods The clinical data of 193 patients with SiewertⅡ / Ⅲ adenocarcinoma of esophageal and gastric carcinoma treated at Linzhou People’s Hospital from October 2014 to December 2015 were reviewed retrospectively. Among them, 58 cases underwent laparoscopic combined with left small incision , 135 cases were treated by a single left chest incision. The operation time, intraoperative blood loss, postoperative total chest drainage, pleural drainage tube time, mediastinal and abdominal lymph node dissection number were analyzed and statistically analyzed. Results The operation time of the endoscopic group was longer than that of the single left and right chest group (P <0.05), but the intraoperative blood loss, total postoperative thoracic drainage, postoperative hospital stay, number of abdominal lymph node dissection, VAS pain score (P <0.05). There was no significant difference in the drainage time and the number of mediastinal lymphadenectasis between the two groups after operation (P> 0.05). The incidences of postoperative complications in both groups were low, 1 case of secondary thoracotomy in the endoscopic group, 1 case of mild esophagogastric anastomotic fistula in 2 cases and pulmonary endoscopic group Infected in 1 case, single lung left chest infection in 5 cases, no intra-abdominal and abdominal incision infection in each group, no perioperative death. Conclusion Laparoscopic combined with left chest small incision for Siewert Ⅱ / Ⅲ AEG surgical treatment has the advantages of less trauma, faster recovery, less incisional pain, thorough lymphadenectomy, adequate intrathoracic esophageal anastomosis, full esophagectomy margin, Worth clinical promotion.