食管胃结合部癌与手术课件

1、Transthoracicvstranshiatalsurgeryforcanceroftheesophagogastricjunction胸外二科鲁方亮2014-10-241Transthoracicvstranshiatalsurg22distal esophageal adenocarcinomas (AEG) true cardia carcinomas (AEG )subcardiac gastric cancers (AEG ).3distal esophageal adenocarcinoSiewert型主要反映出来的是食管下段的病变，故以据病变上缘5-10厘米的部分食管和距病变

2、下缘5厘米的近端胃行切除术，手术入路以经右或左开胸进行为宜； Siewert型主要反映出来的是食管下段的病变，故以据病变Siewert型距病变上缘5厘米的食管下段切除，下缘可行近端胃大部切除或全胃切除术，手术入路以腹-胸两切口或胸腹联合切口为宜；Siewert型距病变上缘5厘米的食管下段切除，下缘可行近Siewert型则为全胃切除和距病变上缘5厘米的食管下段切除术，手术操作主要在腹部，是否需要做全胃切除尚存有争议，特别是早期病变。对于病变局限于黏膜或黏膜下，并且无淋巴结转移的证据，可考虑行近端胃切除术而取代全胃切除术，但其缺点经常造成胃食管返流以及不同程度的食管炎。 Siewert型则为全胃切

3、除和距病变上缘5厘米的食管下段切7788surgical time (A) blood loss (B), 9surgical time (A) blood loss hospital stay time (C) hospital deaths (D)10hospital stay time (C) hospitrandomized controlled trials (A) non-randomized controlled trials (B)11randomized controlled trials (anastomotic leak (A)12anastomotic leak (A)

4、12pulmonary complications (B) cardiovascular complications (C) 13pulmonary complications (B) caA: All Siewert types B: Siewert 14A: All Siewert types B: SieweC: Siewert ; D: Siewert 15C: Siewert ; D: Siewert 15CONCLUSIONThe results indicated a shorter hospital stay, lower 30-d hospital mortality and

5、 decreased pulmonary complications with the transhiatal approach compared with the transthoracic approach. Moreover, a potential survival benefit was achieved for type tumors using the transhiatal approach.16CONCLUSIONThe results indicat17171818Conclusionthere were no significant differences of surv

6、ival rate, postoperative morbidity and mortality between transthoracic resection group and non-transthoracic resection group. 19Conclusionthere were no signifQuestionsTransthoracic : left thoracic, right thoracic, thoracoabdominal approaches;The optimum extent of lymph node resection is still controversial;OS:recommend the transthoracic approach as the preferred option for type I tumors