| 摘要: |
| ［摘要］ 目的 比较微创与开放Sweet食管切除术治疗SiewertⅡ型食管胃结合部腺癌(AEG)的疗效。方法 选取2015年3月至2017年9月安徽医科大学附属省立医院收治的137例AEG患者的临床资料，根据接受手术方式的不同分为微创Sweet食管切除术(MISE)组38例，开放Sweet食管切除术（OSE)组99例。比较两组术中指标及术后疗效情况。结果 与OSE组相比，MISE组术中出血量较少，手术时间更长，淋巴结清扫总数及腹腔淋巴结清扫数更多，差异有统计学意义（P<0.05）。两组共有45例（32.85%）患者术后发生2级以上并发症，均以肺部感染为最常见；4级以上严重并发症主要为严重吻合口瘘和呼吸衰竭。OSE组2～3级并发症发生率高于MISE组，差异有统计学意义（P<0.05）。MISE组和OSE组的1年生存率分别为92.1%和87.9%，3年生存率分别为68.2%和59.6%，两组术后生存情况比较差异无统计学意义（P=0.383）。两组术后复发、转移的发生情况比较差异无统计学意义（P>0.05）。Cox回归分析结果显示，以N0期为参考，N3期是影响患者生存时间的独立不良因素（P<0.05）。结论 相较于OSE术式，MISE术式未能改善SiewertⅡ型AEG患者的生存预后，但术中出血量少，术后并发症发生较少，有利于患者的快速康复。 |
| 关键词: 食管胃结合部腺癌 微创Sweet食管切除术 开放Sweet食管切除术 疗效 |
| DOI：10.3969/j.issn.1674-3806.2022.01.13 |
| 分类号:R 735 |
| 基金项目:安徽省自然科学基金项目（编号：1708085MH182） |
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| Comparison of the efficacy of minimally invasive and open Sweet esophagectomy in treatment of Siewert type Ⅱ adenocarcinoma of the esophagogastric junction |
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LI Huan, MEI Xin-yu
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Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, China
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| Abstract: |
| ［Abstract］ Objective To compare the efficacy of minimally invasive and open Sweet esophagectomy in treatment of Siewert type Ⅱ adenocarcinoma of the esophagogastric junction(AEG). Methods The clinical data of 137 AEG patients admitted to Anhui Provincial Hospital Affiliated to Anhui Medical University from March 2015 to September 2017 were selected, and the patients were divided into the minimally invasive Sweet esophagectomy(MISE) group(38 cases) and the open Sweet esophagectomy(OSE) group(99 cases) according to the different surgical methods. The intraoperative indicators and postoperative curative effect were compared between the two groups. Results Compared with the OSE group, the MISE group had less intraoperative blood loss, longer operation time, and more total number of lymph node dissections and number of abdominal lymph node dissections, and the differences were statistically significant(P<0.05). A total of 45 patients(32.85%) in the two groups had postoperative complications of grade 2 and above, and lung infection was the most common complication. The major serious complications of grade 4 and above were mainly severe anastomotic leakage and respiratory failure. The incidence of grade 2-3 complications in the OSE group was higher than that in the MISE group, and the differences were statistically significant(P<0.05). The 1-year survival rates of the MISE group and the OSE group were 92.1% and 87.9%, respectively, and the 3-year survival rates of the MISE group and the OSE group were 68.2% and 59.6%, respectively. There was no significant difference in postoperative survival between the two groups(P=0.383). There were no significant differences in postoperative recurrence and metastasis between the two groups(P>0.05). The results of Cox regression analysis showed that with N0 stage as the reference, N3 stage was an independent adverse factor affecting the patients′ survival time(P<0.05). Conclusion Compared with the OSE procedure, the MISE procedure fails to improve the survival prognosis of the patients with Siewert type Ⅱ AEG. However, the patients receiving MISE procedure have less intraoperative blood loss and less postoperative complications, which is more conducive to rapid recovery. |
| Key words: Adenocarcinoma of the esophagogastric junction(AEG) Minimally invasive Sweet esophagectomy(MISE) Open Sweet esophagectomy(OSE) Efficacy |
