资源描述
Transthoracicvstranshiatalsurgeryforcanceroftheesophagogastricjunction1Transthoracicvstranshiatalsurg22distal esophageal adenocarcinomas distal esophageal adenocarcinomas(AEG)(AEG)true cardia carcinomas(AEG)true cardia carcinomas(AEG)subcardiac gastric cancers(AEG).subcardiac gastric cancers(AEG).3distal esophageal adenocarcinoSiewertSiewert型主要反映出来的是食管下段的型主要反映出来的是食管下段的病变，故以据病变上缘病变，故以据病变上缘5-105-10厘米的部分食厘米的部分食管和距病变下缘管和距病变下缘5 5厘米的近端胃行切除术，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；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4SiewertSiewert型型距距病病变变上上缘缘5 5厘厘米米的的食食管管下下段段切切除除，下下缘缘可可行行近近端端胃胃大大部部切切除除或或全全胃胃切切除除术术，手手术术入入路路以以腹腹-胸胸两两切切口口或或胸胸腹腹联联合合切口为宜；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5SiewertSiewert型则为全胃切除和距病变上缘型则为全胃切除和距病变上缘5 5厘米的食管下段切除术，手术操作主要在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，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其缺点经常造成胃食管返流以及不同程度的食管炎。的食管炎。Siewert型则为全胃切除和距病变上缘5厘米的食管下段切67788surgical time(A)surgical time(A)blood loss(B),blood loss(B),9surgical time(A)blood loss hospital stay time(C)hospital stay time(C)hospital deaths(D)hospital deaths(D)10hospital stay time(C)hospitrandomized controlled trials(A)randomized controlled trials(A)non-randomized controlled trials(B)non-randomized controlled trials(B)11randomized controlled trials(anastomotic leak(A)anastomotic leak(A)12anastomotic leak(A)12pulmonary complications(B)pulmonary complications(B)cardiovascular complications(C)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 The results indicated a shorter hospital stay,lower 30-d hospital hospital stay,lower 30-d hospital mortality and decreased pulmonary mortality and decreased pulmonary complications with the transhiatal complications with the transhiatal approach compared with the approach compared with the transthoracic approach.transthoracic approach.Moreover,a potential survival Moreover,a potential survival benefit was achieved for type benefit was achieved for type tumors using the transhiatal tumors using the transhiatal approach.approach.16CONCLUSIONThe results indicat17171818Conclusionthere were no significant differences there were no significant differences of survival rate,postoperative of survival rate,postoperative morbidity and mortality between morbidity and mortality between transthoracic resection group and transthoracic resection group and non-transthoracic resection group.non-transthoracic resection group.19Conclusionthere were no signifQuestionsTransthoracic:left thoracic,right Transthoracic:left thoracic,right thoracic,thoracoabdominal thoracic,thoracoabdominal approaches;approaches;The optimum extent of lymph node The optimum extent of lymph node resection is still controversial;resection is still controversial;OS:recommend the transthoracic OS:recommend the transthoracic approach as the preferred option for approach as the preferred option for type I tumors and the transhiatal type I tumors and the transhiatal approach for type and tumors;approach for type and tumors;20QuestionsTransthoracic:left THANKS!THANKS!21THANKS!21
展开阅读全文