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目的:探讨SiewertⅡ、SiewertⅢ型食管胃结合部腺癌(AEG)合理的手术方式。方法:回顾性分析91例SiewertⅡ、SiewertⅢ型AEG患者的临床资料,42例患者采取左侧经胸手术入路,49例患者采取上腹部切口手术入路。比较两组患者手术时间、术中出血量、淋巴结清扫数、术后住院天数、术后并发症发生率等临床资料。结果:两组均未发生围手术期死亡,并且达到R0切除。经胸手术组与经腹食管裂孔手术组在手术所需时间、术中出血总量、腹腔淋巴结清扫数、术后住院天数比较,差异均具有统计学意义(P<0.05)。两组手术相关并发症发生率差异具有统计学意义(P<0.05)。但两组患者纵隔淋巴结清扫数量差异无统计学意义(P>0.05)。结论:SiewertⅡ、SiewertⅢ型AEG患者选经腹食管裂孔方式清扫淋巴结更彻底、术后并发症发生率低、恢复快,较经胸手术入路更为合理。
OBJECTIVE: To explore a reasonable surgical approach for Siewert II and Siewert III esophageal and gastric adenocarcinoma (AEG). Methods: The clinical data of 91 patients with Siewert II and Siewert type III AEG were retrospectively analyzed. 42 patients were treated with transthoracic surgery on the left side and 49 patients were treated with incisions on the upper abdominal incision. The operative time, intraoperative blood loss, number of lymph node dissections, postoperative days of hospitalization, postoperative complications, and other clinical data were compared between the two groups. Results: No perioperative death occurred in both groups and R0 resection was achieved. The time required for operation, the total amount of intraoperative hemorrhage, the number of peritoneal lymph node dissections, and the number of hospital stays after operation in the transthoracic surgery group and the abdominal esophageal hiatal surgery group were statistically significant (P<0.05). There was a statistically significant difference in the incidence of surgery-related complications between the two groups (P<0.05). However, there was no significant difference in the number of mediastinal lymph node dissections between the two groups (P>0.05). Conclusion: Siewert II and Siewert type III AEG patients undergoing abdominal esophageal hiatal dissection clear lymph nodes more completely, have lower incidence of postoperative complications, and recover faster, which is more reasonable than transthoracic surgery.