贾子豫　符涛　步召德　张小田　李永恒　唐磊　李忠武　季加孚



进展期食管胃结合部癌多学科协作诊疗1例

贾子豫符涛步召德张小田李永恒唐磊李忠武季加孚

摘要食管胃结合部（esophageal gastric junction，EGJ）癌的生物学特性不同于胃癌和食管癌，其初始治疗的选择尤为重要。本文介绍了1例进展期食管胃结合部癌病例，试图通过多学科协作的方式指导治疗，对放化疗的治疗模式进行总结，以期给患者带来更好的预后，并对胃上部癌治疗模式提出新的策略，以助于制定规范的临床路径及治疗指南。

关键词食管胃结合部癌术前放化疗多学科协作

Multidisciplinary treatment for a patient with locally advanced esophagogastric junction cancer

Ziyu JIA, Tao FU, Zhaode BU, Xiaotian ZHANG, Yongheng LI, Lei TANG, Zhongwu LI, Jiafu JI
Correspondence to: Jiafu JI; E-mail: jiafuji@hotmail.com
Department of Gastrointestinal Surgery, Beijing Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University School of Oncology, Beijing 100142, China

Abstract Since the biological characteristics of esophageal gastric junction (EGJ) cancer are different from those of gastric cancer and esophageal cancer, the choice of initial treatment is particularly important. This article introduces a case of locally advanced EGJ cancer with single metastasis factor treated with preoperative radiochemotherapy in the Beijing Cancer Hospital. Through the multidisciplinary team, we aim to achieve a better prognosis for this patient and propose new treatment practices for EGJ cancer.

Keywords:EGJ cancer, preoperative radiochemotherapy, multidisciplinary team

1　病历摘要

患者女，76岁，主因“进食哽噎感1月余”于2015 年3月就诊于外院，胃镜提示：贲门小弯侧巨大溃疡，活检病理提示为低分化腺癌。后转诊至本院门诊，予以术前分期检查。腹部增强CT提示食管胃结合部胃壁增厚，较厚处14 mm，增强扫描强化明显，病变向上累及腹段食管，向下侵犯达近端胃体，与正常胃壁分界不清，浆膜面模糊。病变后方与胰腺脂肪间隙清晰。No.3、7、8、16组多发肿大淋巴结，较大约32 mm×16 mm。网膜及腹膜未见增厚，未见腹水。胃镜提示食管下端距门齿39～43 cm（齿状线距门齿约41 cm），可见溃疡性病变，累及环周，贲门口明显缩窄，延伸累及胃底、近端胃体，活检质硬。上消化道造影（图1）提示食管胃交界区黏膜破坏，以贲门口为中心可见不规则充盈缺损，黏膜破坏中断，环堤局部破坏，范围约4 cm，累及下段食管长度约2.0 cm。活检病理回报：食管胃结合部中低分化腺癌，Lauren肠型，HP（-）。……