食管胃结合部腺癌手术入路合理选择

除术后双通道法与传统R-Y的优劣：两者在术后体重减轻、实验室营养状态指标改变以及生活质量等方面均未发现差异有统计学意义。造成的原因首先可能是十二指肠通路的优势只有在排空时间有效延长时才能体现。十二指肠近口侧加空肠储袋可以延缓食物进入十二指肠的时间。其次，双通路法并无储袋作用，术后上消化道造影发现，绝大多数病例造影剂均匀排入十二指肠和空肠。

近端胃次全切除仅适用于早期胃癌，残胃容量>1/2以上的病例可以采取食管胃前壁单层套入式吻合；残胃容量< 1/2时根据术者经验可以选择管状胃-食管吻合，或间置空肠、空肠袋间置空肠吻合；双通道也是重建方法，但是同时加近口端空肠储袋可能有助于改善病人的生活质量。但是上述方法均缺乏高级别的循证医学证据，孰优孰劣有待多中心随机临床试验证实。

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（2011-12-01收稿）文章编号：1005-2008（2012）04-0295-03

食管胃结合部腺癌手术

入路合理选择

所剑，王大广，夏明杰

【摘要】食管胃结合部腺癌（AEG）与传统意义上的食管癌及胃癌存在较大差异。随着对其淋巴结转移规律的总结和认识，目前认为仅对于以纵隔淋巴结转移为主的Siewert I型AEG，经胸或左胸腹联合切口可作为其推荐的手术入路。对于以腹腔淋巴结转移为主的SiewertⅡ/Ⅲ型AEG，经胸入路及胸腹联合入路与开腹手术相比手术风险大、住院时间延长，且不改善病人长期存活率。由于较少合并纵隔淋巴结转移，经腹入路可作为SiewertⅡ/Ⅲ型肿瘤合理的手术选择。

【关键词】食管胃结合部腺癌；淋巴结清扫；手术入路

中图分类号：R6文献标志码：A

Reasonable option of surgical approach for adenocarcinoma of the esophagogastric junction SUO

作者单位：吉林大学第一医院普外科，吉林长春130021

通讯作者：所剑，E-mail：suojian0066@