摘要
近年来胃癌发病率呈逐渐下降趋势,然而食管胃结合部腺癌(AEG)的发病率却逐渐上升。AEG不同于食管癌和胃癌,具有独特的病理学类型,其早期诊断率较低,预后较差。目前手术是治疗进展期Siewert Ⅱ、Ⅲ型AEG的最主要治疗措施。手术的关键是肿瘤完整切除和淋巴结彻底清扫,尤其是腹上区和下纵隔淋巴结(主要是第110组下段食管旁淋巴结和第111组膈上淋巴结)。对于下段食管受侵犯的进展期Siewert Ⅱ、Ⅲ型AEG患者而言,需行胃切除+腹上区和下纵隔淋巴结在内的D2淋巴结清扫术。目前临床上对于肿瘤完整切除和腹腔淋巴结清扫已达成共识,但对于下纵隔淋巴结,尤其是下段食管旁和膈上淋巴结的清扫仍存在争议。由于食管胃结合部特殊的淋巴液引流途径,清扫下纵隔淋巴结有其必要性。下纵隔淋巴结的转移率决定了下纵隔淋巴结的清扫范围。D2淋巴结清扫术(包含下纵隔淋巴结)能较彻底清扫食管胃结合部周围淋巴结,可改善患者预后,提高患者术后生存率。
In recent years, the incidence of gastric cancer has shown a decreasing trend. However, the incidence of adenocarcinoma of the esophagogastric junction (AEG) is gradually increasing. Different from esophageal cancer and gastric cancer, AEG has distinct pathological types, with low early diagnostic rate and poor prognosis. At present, the main therapeutic measure is surgery for advanced Siewert type Ⅱ and Ⅲ AEG. The key to a successful operation is complete resection of tumor and thorough lymphadenectomy, especially the upper abdominal and inferior mediastinal lymph nodes (No.110 the lower thoracic paraesophageal lymph nodes and No.111 the supradiaphragmatic lymph nodes). For the advanced Siewert type Ⅱ and Ⅲ AEG invading lower thoracic esophagus, it is required to perform gastrectomy with D2 lymphadenectomy, which includes upper abdominal and inferior mediastinal lymphadenectomy. There has been reached a consensus on complete resection of tumor and thorough lymphadenectomy. However, there is still controversy in the inferior mediastinal lymphadenectomy, particularly lower thoracic paraesophageal lymph nodes and supradiaphragmatic lymph nodes. Since specific lymphatic drainage of the esophagogastric junction, it is necessary to dissect inferior mediastinal lymph nodes. The metastatic rate of the inferior mediastinal lymph nodes determines the extent of inferior mediastinal lymphadenectomy. D2 lymphadenectomy (including inferior mediastinal lymphadenectomy) could achieve more thorough clearance for perigastric metastatic lymph nodes. Meanwhile, it could increase the survival rate of postoperative patients and improve their prognosis.
作者
王杰
程启升
刘勇
梅相煌
胡文庆
Wang Jie;Cheng Qisheng;Liu Yong;Mei Xianghuang;Hu Wenqing(Department of Gastrointestinal Surgery, the Affiliated Heji Hospital, Changzhi Medical College, Changzhi 046000, Shanxi Province, China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2019年第3期292-296,共5页
Chinese Journal of Digestive Surgery
基金
山西省重大研究和发展项目( 201703D321008)
山西省“服务产业创新学科群建设计划”项目(201809)
山西省“1331”重点创新团队建设计划资助
山西省、研究上教育创新项目(201XSY093).
关键词
食管胃结合部腺癌
胃肿瘤
进展期
淋巴结清扫
下纵隔淋巴结
Adenocarcinoma of the esophagogastric junction
Gastric neoplasms
Advanced
Lymphadenectomy
Inferior mediastinal lymph nodes
