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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SiewertI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。
Esophagogastric junction adenocarcinoma (AEG) and the traditional sense of esophageal and gastric cancer there is a big difference. With the summary and understanding of the rule of lymph node metastasis, it is currently considered that the SiewertI type AEG, which is mainly based on the mediastinal lymph node metastasis, may be the recommended surgical approach for transthoracic or left thoracic abdominal incision. For Siewert Ⅱ / Ⅲ AEG, which is mainly composed of peritoneal lymph node metastasis, the operation risk is longer and the hospitalization time is longer than that of laparotomy via transthoracic and thoracoabdominal combined approach. And it does not improve the long-term survival rate of patients. Due to less combined mediastinal lymph node metastases, transabdominal approach can be used as a reasonable surgical choice for Siewert type II / III tumors.