52例食管胃结合部腺癌的诊断与治疗

2017-10-12史晓洋董明周建平孔凡民

中国医科大学学报 2017年10期

关键词：胃癌手术

史晓洋，董明，周建平，孔凡民

（中国医科大学附属第一医院胃肠外科，沈阳 110001）

52例食管胃结合部腺癌的诊断与治疗

史晓洋，董明，周建平，孔凡民

（中国医科大学附属第一医院胃肠外科，沈阳 110001）

目的探讨食管胃结合部腺癌（AEG）的诊断与治疗方法。方法回顾性分析2011年6月至2016年5月于我科行手术治疗的AEG患者52例的病历资料。结果诊断方面，除了癌胚抗原（CEA），糖类抗原CA19-9也是AEG术前阳性率较高的肿瘤标志物；对于术式选择，Ⅰ型患者采取经胸食管切除，Ⅱ型、Ⅲ型患者主要采取经腹根治性全胃切除术；Ⅲ期肿瘤最为常见，肺内感染是最常见的术后并发症。结论AEG仍然是临床棘手问题之一，持续性上腹部不适及进食后不适的中老年患者应引起注意。合理的术式选择是保证临床根治的基础，Ⅱ型患者应首选根治性全胃切除术及经食管裂孔的远端食管切除术，相比于Ⅲ型患者更易造成食管近端切缘残留，必要时应联合经胸入路保证手术根治性。

食管胃结合部腺癌； Siewert分型；诊断；术式；术后管理

Abstract ObjectivePerforming special studies in patients with adenocarcinomas of the esophagogastric junction （AEG） can provide an effective clinical basis for diagnosis and successful treatment.MethodsWe retrospectively analyzed and summarized the diagnosis，operative procedure，and postoperative complications in 52 cases of AEG in patients who underwent surgical treatment at the First Hospital of China Medical University between June 2011 and May 2016.ResultsIn addition to carcinoembryonic antigen （CEA），carbohydrate antigen 19-9 （CA19-9） is a useful tumor marker with a positively higher rate of preoperative detection of AEG. With respect to choice of surgical approach，typeⅠtumors were treated using transthoracic en bloc esophagectomy with resection of the proximal stomach，while typeⅡand III tumors were primarily treated with an extended total gastrectomy with transhiatal resection of the distal esophagus. We observed in our study that stage Ⅲ tumors were the most common type，and intra-pulmonary infection was the commonest postoperative complication.ConclusionAEG continues to remain one of the most difficult clinical problems. Middle-aged and elderly patients presenting with persistent epigastric and postprandial discomfort require special attention. Adopting a rational surgical strategy is the basis of achieving radical cure. We propose that patients with typeⅡtumors should be treated with a radical total gastrectomy，and a distal esophagectomy through the esophageal hiatus，if necessary，should be combined with a thoracic approach to ensure radical surgery.

Keywordsadenocarcinoma of the esophagogastric junction； Siewert types；diagnosis；surgical approach； postoperative management

近年来，食管胃结合部腺癌（adenocarcionmas of the esophagogastric junction，AEG）发病率呈上升趋势。对AEG的诊断、手术方式、淋巴结清扫范围等问题仍有争议。针对AEG的专题研究可以为AEG的诊治提供有效的临床依据。本研究对2011年6月至2016年5月于中国医科大学附属第一医院胃肠外科行手术治疗的52例AEG患者进行回顾性分析，旨在总结AEG的诊断、术式、术后并发症等经验。