胸腹腔镜联合经左胸、上腹入路与经左胸入路对siewert Ⅱ型食管胃交界处腺癌的疗效比较
Thoracic laparoscopy in the left thoracic and epigastric approach versus left thoracic approach in the treatment of Siewert type Ⅱ adenocarcinoma of the esophagogastric junction
宋雪冰 1杨蒙蒙 1赵焓 1张午临 1贾涛 1马玉泉1
作者信息
- 1. 056008 河北省邯郸市中心医院胸外二科
- 折叠
摘要
目的 探讨胸腹腔镜联合经左胸、上腹入路和经左胸入路两种不同术式对食管胃交界处腺癌(AEG)患者的疗效.方法 回顾性分析 2019 年 6 月至 2022 年 12 月期间在邯郸市中心医院接受根治性切除术的 109 例SiewertⅡ型AEG患者的临床病理资料.根据手术方式将患者分为2 组:经左胸入路(经左胸组,n=61)和胸腹腔镜联合经左胸、上腹入路(胸腹联合组,n=48).比较 2 组患者手术时间、出血量、近端切除切缘长度、清扫淋巴结数目、住院时间、术后并发症、生存情况和生活质量.结果 胸腹联合组肿瘤边缘长度短于经左胸组(P＜0.05),其余年龄、性别、肿瘤分期等差异均无统计学意义(P＞0.05).胸腹联合组手术时间长于经左胸组(P＜0.05),而术中出血量少于经左胸组(P＜0.05),住院时间短于经左胸组(P＜0.05),清扫淋巴结总数多于经左胸组(P＜0.05).经左胸组术后并发症发生率为 18.03%,胸腹联合组术后并发症发生率为 14.58%,差异无统计学意义(P＞0.05).胸腹联合组在术后 1周和 3 周身体功能、情绪功能和总健康水平均高于经左胸组(P＜0.05).胸腹联合组在术后 1 年和术后 2 年生存率高于经左胸组(P＜0.05).结论 胸腹腔镜联合经左胸、上腹入路治疗Siewert Ⅱ型 AEG 患者安全性更高,近期疗效更好,并且在胸和腹部淋巴结清扫术中优于左经胸入路.
Abstract
Objective To explore the efficacy of thoracic laparoscopy in the left thoracic and epigastric approach versus left thoracic approach in the treatment of Siewert type Ⅱ adenocarcinoma of the esophagogastric junction(AEG).Methods Clinicopathological data of 109 patients with Siewert type Ⅱ AEG who underwent radical resection in Handan Central Hospital between June 2019 and December 2022 were retrospectively analyzed.According to the surgical method,patients were divided into the left thoracic and epigastric approach group and left thoracic approach group.The operation time,blood loss,length of proximal resection margin,number of removed lymph nodes,length of stay,postoperative complications,survival and quality of life were compared between the two groups.Results The length of tumor margins in the left thoracic and epigastric approach group was significantly shorter than that of the left thoracic approach group(P＜0.05),and the other data like age,sex and tumor staging were comparable(P＞0.05).Patients in the left thoracic and epigastric approach group had significantly longer operation time,less intraoperative bleeding,shorter length of stay and greater number of removed lymph nodes than those of the left thoracic approach group(all P＜0.05).There was no significant difference in the postoperative complication rate between the left thoracic and epigastric approach group and the left thoracic approach group(18.03%vs 14.58%,P＞0.05).Physical function,emotional function,and overall health at 1 week and 3 weeks postoperatively were significantly better in the left thoracic and epigastric approach group than those of the left thoracic approach group(P＜0.05).The 1-year and 2-year survival were significantly higher in the left thoracic and epigastric approach group than those of the left thoracic approach group(P＜0.05).Conclusion Thoracic laparoscopy in the left thoracic and epigastric approach has higher safety and better short-term efficacy on patients with Siewert type Ⅱ AEG than the left thoracic approach,especially in thoracic and abdominal lymph node dissection.
关键词
Siewert/Ⅱ型/食管胃交界处腺癌/胸腹腔镜Key words
Siewert type Ⅱ/adenocarcinoma of the esophagogastric junction/thoracic laparoscopy引用本文复制引用
出版年
2024
NETL
NSTL
万方数据