摘要
食管胃结合部腺癌(AEG)在胃癌中的比例呈逐步上升的趋势。由于该部位的肿瘤具有独特的解剖结构及生物学特征,使其在诊断、治疗的多个方面具有一定复杂性,给手术方式、切除范围的选择、淋巴结清扫、治疗决策的制订等带来诸多的难度,也因此一直是学术争论的焦点。随着近年来微创外科的发展,腹腔镜技术已不断成熟并广泛应用于消化道肿瘤的治疗。相比于远端胃癌,AEG的微创治疗处于发展相对滞后的状态,也有一系列的问题尚未明确。本文围绕AEG近端胃切除术及淋巴结清扫两个方面对近年来的研究进展进行了回顾和总结。腹腔镜辅助近端胃大部切除术对于早期近端胃癌是安全的,并且具有与全胃切除相似的远期疗效,但需严格把握手术指征。AEG的腹腔淋巴结转移以No.1、No.2、No.3、No.7淋巴结为主,而纵隔淋巴结转移与浸润食管的距离密切相关。经腹食管裂孔入路(TH)可以获得足够的淋巴结清扫数目,且具有较好的安全性和有效性,是早期AEG首选的手术入路。CLASS-10的研究结果可以为腹腔镜纵隔淋巴结清扫提供更高级别的循证学依据。AEG的腹腔镜手术应在经验丰富的单位谨慎开展,并应注重临床研究开展。
The proportion of adenocarcinoma of the esophagogastric junction(AEG)in gastric cancer is gradually increasing.Due to the unique anatomical structure and biological characteristics of the tumor at this site,AEG has a certain degree of complexity in many aspects of diagnosis and treatment,which brings difficulties to the operation method,the selection of the resection range,the lymph node dissection and the treatment decision⁃making.Therefore,AEG has always been the focus of academic debate.With the development of minimally invasive surgery in recent years,laparoscopic technology has been increasingly mature and widely used in the treatment of gastrointestinal tumors.Compared with distal gastric cancer,the minimally invasive treatment of AEG is in a lagging state,and there are also a series of problems that have not yet reached a consensus.This article reviews and summarizes the recent research progress in two aspects:proximal gastrectomy for AEG and lymph node dissection.Laparoscopic⁃assisted proximal gastrectomy is safe for early proximal gastric cancer and has a long⁃term survival outcome not inferior to total gastrectomy,but the surgical indications must be strictly selected.Abdominal lymph node metastasis of AEG is mainly in group 1,2,3,and 7,and mediastinal lymph node metastasis is closely related to the length of the infiltrated esophagus.The abdominal transhiatal(TH)approach can obtain a sufficient number of harvested lymph node,and has good safety and efficacy,which is the first⁃choice of surgical approach for early AEG.The results of the CLASS⁃10 clinical trial can provide a higher level of evidence for laparoscopic mediastinal lymph node dissection.Laparoscopic surgery for AEG should be carried out in experienced medical center based on clinical research.
作者
赵骏杰
刘凤林
Zhao Junjie;Liu Fenglin(Department of General Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《中华胃肠外科杂志》
CSCD
北大核心
2022年第2期114-119,共6页
Chinese Journal of Gastrointestinal Surgery
基金
国家自然科学基金(82172803)。
关键词
食管胃结合部腺癌
腹腔镜手术
近端胃切除
淋巴结清扫
下纵隔淋巴结
Adenocarcinoma of the esophagogastric junction
Laparoscopic surgery
Proximal gastrectomy
Lymph node resection
Inferior mediastinal lymph nodes
作者简介
通信作者:刘凤林,Email:liu.fenglin@zs⁃hospital.sh.cn。
