52例食管胃結合部腺癌的診斷與治療

史曉洋，董明，周建平，孔凡民

（中國醫科大學附屬第一醫院胃腸外科，沈陽 110001）

52例食管胃結合部腺癌的診斷與治療

史曉洋，董明，周建平，孔凡民

（中國醫科大學附屬第一醫院胃腸外科，沈陽 110001）

目的探討食管胃結合部腺癌（AEG）的診斷與治療方法。方法回顧性分析2011年6月至2016年5月于我科行手術治療的AEG患者52例的病歷資料。結果診斷方面，除了癌胚抗原（CEA），糖類抗原CA19-9也是AEG術前陽性率較高的腫瘤標志物；對于術式選擇，Ⅰ型患者采取經胸食管切除，Ⅱ型、Ⅲ型患者主要采取經腹根治性全胃切除術；Ⅲ期腫瘤最為常見，肺內感染是最常見的術后并發癥。結論AEG仍然是臨床棘手問題之一，持續性上腹部不適及進食后不適的中老年患者應引起注意。合理的術式選擇是保證臨床根治的基礎，Ⅱ型患者應首選根治性全胃切除術及經食管裂孔的遠端食管切除術，相比于Ⅲ型患者更易造成食管近端切緣殘留，必要時應聯合經胸入路保證手術根治性。

食管胃結合部腺癌； Siewert分型； 診斷； 術式； 術后管理

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

近年來，食管胃結合部腺癌（adenocarcionmas of the esophagogastric junction，AEG）發病率呈上升趨勢。對AEG的診斷、手術方式、淋巴結清掃范圍等問題仍有爭議。針對AEG的專題研究可以為AEG的診治提供有效的臨床依據。本研究對2011年6月至2016年5月于中國醫科大學附屬第一醫院胃腸外科行手術治療的52例AEG患者進行回顧性分析，旨在總結AEG的診斷、術式、術后并發癥等經驗。

1 材料與方法

1.1 一般資料

回顧性分析2011年6月至2016年5月于中國醫科大學附屬第一醫院胃……