食管胃结合部癌与手术

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1、Transthoracicvstranshiatalsurgeryforcanceroftheesophagogastricjunction胸外二科鲁方亮2014-10-2412distalesophagealadenocarcinomas(AEGⅠ)truecardiacarcinomas(AEGⅡ)subcardiacgastriccancers(AEGⅢ).3SiewertⅠ型主要反映出来的是食管下段的病变，故以据病变上缘5-10厘米的部分食管和距病变下缘5厘米的近端胃行切除术，手术入路以

2、经右或左开胸进行为宜；SiewertⅡ型距病变上缘5厘米的食管下段切除，下缘可行近端胃大部切除或全胃切除术，手术入路以腹-胸两切口或胸腹联合切口为宜；SiewertⅢ型则为全胃切除和距病变上缘5厘米的食管下段切除术，手术操作主要在腹部，是否需要做全胃切除尚存有争议，特别是早期病变。对于病变局限于黏膜或黏膜下，并且无淋巴结转移的证据，可考虑行近端胃切除术而取代全胃切除术，但其缺点经常造成胃食管返流以及不同程度的食管炎。78surgicaltime(A)bloodloss(B),9hospitals

3、taytime(C)hospitaldeaths(D)10randomizedcontrolledtrials(A)non-randomizedcontrolledtrials(B)11anastomoticleak(A)12pulmonarycomplications(B)cardiovascularcomplications(C)13A:AllSiewerttypesB:SiewertⅠ14C:SiewertⅡ;D:SiewertⅢ15CONCLUSIONTheresultsindica

4、tedashorterhospitalstay,lower30-dhospitalmortalityanddecreasedpulmonarycomplicationswiththetranshiatalapproachcomparedwiththetransthoracicapproach.Moreover,apotentialsurvivalbenefitwasachievedfortypeⅢtumorsusingthetranshiatalapproach.161718Conclusiont

5、herewerenosignificantdifferencesofsurvivalrate,postoperativemorbidityandmortalitybetweentransthoracicresectiongroupandnon-transthoracicresectiongroup.19QuestionsTransthoracic:leftthoracic,rightthoracic,thoracoabdominalapproaches;Theoptimumextentoflymp

6、hnoderesectionisstillcontroversial;OS:recommendthetransthoracicapproachasthepreferredoptionfortypeItumorsandthetranshiatalapproachfortypeⅡandⅢtumors;20THANKS!21