食管胃結(jié)合部癌與手術(shù)課件

1、Transthoracicvstranshiatalsurgeryforcanceroftheesophagogastricjunction胸外二科魯方亮2014-10-241Transthoracicvstranshiatalsurg22distal esophageal adenocarcinomas (AEG) true cardia carcinomas (AEG )subcardiac gastric cancers (AEG ).3distal esophageal adenocarcinoSiewert型主要反映出來的是食管下段的病變，故以據(jù)病變上緣5-10厘米的部分食管和距病變

2、下緣5厘米的近端胃行切除術(shù)，手術(shù)入路以經(jīng)右或左開胸進行為宜； Siewert型主要反映出來的是食管下段的病變，故以據(jù)病變Siewert型距病變上緣5厘米的食管下段切除，下緣可行近端胃大部切除或全胃切除術(shù)，手術(shù)入路以腹-胸兩切口或胸腹聯(lián)合切口為宜；Siewert型距病變上緣5厘米的食管下段切除，下緣可行近Siewert型則為全胃切除和距病變上緣5厘米的食管下段切除術(shù)，手術(shù)操作主要在腹部，是否需要做全胃切除尚存有爭議，特別是早期病變。對于病變局限于黏膜或黏膜下，并且無淋巴結(jié)轉(zhuǎn)移的證據(jù)，可考慮行近端胃切除術(shù)而取代全胃切除術(shù)，但其缺點經(jīng)常造成胃食管返流以及不同程度的食管炎。 Siewert型則為全胃切

3、除和距病變上緣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