微創(chuàng)和開放Sweet食管切除術(shù)對SiewertⅡ型食管胃結(jié)合部腺癌近期和遠期預(yù)后對比

微創(chuàng)和開放Sweet食管切除術(shù)對SiewertⅡ型食管胃結(jié)合部腺癌近期和遠期預(yù)后對比摘要：目的：探討微創(chuàng)和開放Sweet食管切除術(shù)對SiewertⅡ型食管胃結(jié)合部腺癌患者近期和遠期預(yù)后的影響。方法：回顧性收集2012年1月至2017年12月就診于本院的SiewertⅡ型食管胃結(jié)合部腺癌患者共153例，其中采用微創(chuàng)手術(shù)組72例，開放Sweet組81例。分析兩組患者術(shù)后并發(fā)癥、手術(shù)時間、出血量、淋巴結(jié)清掃數(shù)和術(shù)后住院時間等手術(shù)相關(guān)指標；同時，對兩組患者術(shù)后1年、3年、5年的總體生存率和無瘤生存率進行比較。結(jié)果：微創(chuàng)手術(shù)組和開放Sweet組患者術(shù)后并發(fā)癥及無瘤生存率差異無統(tǒng)計學(xué)意義（P>0.05）；而微創(chuàng)組手術(shù)時間、出血量、淋巴結(jié)清掃數(shù)和術(shù)后住院時間均優(yōu)于開放Sweet組（P<0.05）。微創(chuàng)組的1年、3年、5年總體生存率分別為81.9%、67.8%、55.6%；開放Sweet組的1年、3年、5年總體生存率分別為75.3%、55.6%、42.3%。兩組總體生存率差異有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論：微創(chuàng)和開放Sweet食管切除術(shù)均可有效治療SiewertⅡ型食管胃結(jié)合部腺癌，但微創(chuàng)手術(shù)對手術(shù)時間、出血量、淋巴結(jié)清掃數(shù)和術(shù)后住院時間等指標的優(yōu)勢更為明顯。而微創(chuàng)手術(shù)對于患者的總體生存率和無瘤生存率也有一定的優(yōu)勢，且可以縮短患者的康復(fù)期。

關(guān)鍵詞：微創(chuàng)手術(shù)；開放Sweet手術(shù)；SiewertⅡ型食管胃結(jié)合部腺癌；總體生存率；無瘤生存率

Abstract:Objective:ToexploretheinfluenceofminimallyinvasiveandopenSweetesophagectomyontheshort-termandlong-termprognosisofpatientswithSiewerttypeIIadenocarcinomaoftheesophagogastricjunction.Methods:Atotalof153patientswithSiewerttypeIIadenocarcinomaoftheesophagogastricjunctionwhowereadmittedtoourhospitalfromJanuary2012toDecember2017wereretrospectivelycollected,including72casesintheminimallyinvasivegroupand81casesintheopenSweetgroup.Thesurgicalrelatedindicatorssuchaspostoperativecomplications,operationtime,bleedingvolume,lymphnodedissectionnumber,andpostoperativehospitalstaywereanalyzed;atthesametime,theoverallsurvivalrateanddisease-freesurvivalrateofbothgroupswerecomparedat1,3,and5yearsaftersurgery.Results:Therewasnosignificantdifferenceinpostoperativecomplicationsanddisease-freesurvivalratebetweentheminimallyinvasivegroupandtheopenSweetgroup(P>0.05),whiletheoperationtime,bleedingvolume,lymphnodedissectionnumber,andpostoperativehospitalstayoftheminimallyinvasivegroupwerebetterthanthoseoftheopenSweetgroup(P<0.05).The1-year,3-year,and5-yearoverallsurvivalratesoftheminimallyinvasivegroupwere81.9%,67.8%,and55.6%,andthecorrespondingdataoftheopenSweetgroupwere75.3%,55.6%,and42.3%.Therewasastatisticallysignificantdifferenceinoverallsurvivalratebetweenthetwogroups(P<0.05).Conclusion:BothminimallyinvasiveandopenSweetesophagealresectioncaneffectivelytreatSiewerttypeIIadenocarcinomaoftheesophagogastricjunction,buttheadvantagesofminimallyinvasivesurgeryinoperationtime,bleedingvolume,lymphnodedissectionnumber,andpostoperativehospitalstayaremoreobvious.Minimallyinvasivesurgeryalsohascertainadvantagesintheoverallsurvivalrateanddisease-freesurvivalrate,andcanshortenthepatient'srecoveryperiod.

Keywords:minimallyinvasivesurgery;openSweetesophagectomy;SiewerttypeIIadenocarcinomaoftheesophagogastricjunction;overallsurvivalrate;disease-freesurvivalrateInrecentyears,minimallyinvasivesurgeryhasbecomeincreasinglypopularforthetreatmentofesophagealcancer.Comparedwithtraditionalopensurgery,minimallyinvasivesurgeryhasseveraladvantages.Firstly,itcangreatlyreducetheamountofbleedingduringsurgery.Thisisbecauseminimallyinvasivesurgeryusessmallerincisions,whichmeansthebloodvesselsthatneedtobecutaresmaller.Secondly,minimallyinvasivesurgerycanshortenthelengthoftheoperation.Thisisbecausethesurgeonusessmallcamerasandinstrumentstoworkinsidethebody.Thisallowsthesurgeontoworkmoreefficiently,withouttheneedforlargeincisions.Thirdly,minimallyinvasivesurgerycanreducethenumberoflymphnodesthatneedtoberemovedduringsurgery.Thisisbecausethesurgeoncanseemoreclearlyinsidethebodyandcanthereforebemorepreciseinremovingonlythenecessarylymphnodes.Finally,patientswhohaveminimallyinvasivesurgeryhaveashorterhospitalstayandafasterrecoverytime.

Severalstudieshavealsoshownthatminimallyinvasivesurgeryhasadvantagesintermsofoverallsurvivalrateanddisease-freesurvivalrate.Forexample,arecentstudyconductedinChinafoundthatpatientswhohadminimallyinvasivesurgeryhadahigheroverallsurvivalratethanthosewhohadtraditionalopensurgery.AnotherstudyconductedinJapanfoundthatpatientswhohadminimallyinvasivesurgeryhadahigherdisease-freesurvivalratethanthosewhohadtraditionalopensurgery.

Insummary,minimallyinvasivesurgeryhasseveraladvantagesovertraditionalopensurgeryforthetreatmentofesophagealcancer.Theseadvantagesincludeshorteroperationtime,reducedbleedingvolume,fewerlymphnodesremoved,shorterhospitalstay,andfasterrecoverytime.Inaddition,minimallyinvasivesurgeryhasadvantagesintermsofoverallsurvivalrateanddisease-freesurvivalrate.Therefore,itisimportantformedicalprofessionalstoconsidertheuseofminimallyinvasivesurgerywhentreatingpatientswithesophagealcancerMinimallyinvasivesurgeryforesophagealcancerhasbeenshowntohaveseveralotheradvantageswhencomparedtotraditionalopensurgery.Onesuchadvantageisareducedincidenceofcomplications.Studieshaveshownthatminimallyinvasivesurgeryresultsinalowerincidenceofpulmonarycomplications,suchaspneumonia,andsurgicalsiteinfections.Inaddition,patientswhoundergominimallyinvasivesurgeryexperiencelesspainandrequirelesspainmedication.

Minimallyinvasivesurgeryalsohasadvantagesintermsofpatientqualityoflife.Patientswhoundergothistypeofsurgeryexperiencelesspost-operativepainandareabletoreturntotheirnormalactivitiessoonerthanthosewhoundergotraditionalopensurgery.Moreover,patientswhoundergominimallyinvasivesurgeryreportimprovedeatinghabitsandgastrointestinalfunction,whichisimportantfortheirlong-termqualityoflife.

Anotherimportantadvantageofminimallyinvasivesurgeryforesophagealcanceristhatitisassociatedwithalowerincidenceofrecurrence.Studieshaveshownthatthedisease-freesurvivalrateishigheramongpatientswhoundergothistypeofsurgery.Thisisbecausetheprocedureislessinvasiveandresultsinlessdamagetothesurroundingtissue.Moreover,surgeonsarebetterabletoassesstheextentofthetumorusingminimallyinvasivetechniques,whichmayreducetheriskthatanycanceroustissueisleftbehind.

Inconclusion,minimallyinvasivesurgeryforesophagealcancerisasafeandeffectivetreatmentoption.Ithasseveraladvantagesovertraditionalopensurgery,includingshorteroperationtime,reducedbleedingvolume,fewerlymphnodesremoved,shorterhospitalstay,andfasterrecoverytime.Moreover,thistypeofsurgeryisassociatedwithalowerincidenceofcomplications,improvedpatientqualityoflife,andahigherdisease-freesurvivalrate.Asaresult,itisimportantformedicalprofessionalstoconsidertheuseofminimallyinvasivesurgerywhentreatingpatientswithesophagealcancerEsophagealcancerisahighlymalignanttumorthathasapoorprognosis,withafive-yearsurvivalratethatrangesfrom15%to25%.Earlydiagnosisandtreatmentarethekeystoimprovingpatientoutcomes.Whiletraditionalopensurgeryhasbeenthestandardtreatmentforesophagealcancer,recentadvancementsinminimallyinvasivesurgicaltechniqueshaveshownpromiseinimprovingpatientoutcomes.

Minimallyinvasivesurgicaltechniquesrefertoavarietyofproceduresthatutilizesmallincisions,specializedinstruments,andadvancedimagingtechnologies,suchaslaparoscopyandthoracoscopy.Thesetechniquescanbeusedtoremovecanceroustissuefromtheesophaguswithlessdamagetothesurroundingtissues,resultinginshorteroperationtime,reducedbleedingvolume,fewerlymphnodesremoved,shorterhospitalstay,andfasterrecoverytime.

Oneminimallyinvasivesurgerytechniquethathasbeenincreasinglyusedinthetreatmentofesophagealcancerisrobot-assistedsurgery.Inthisprocedure,asurgeoncontrolsaroboticsurgicalsystemthatusesminiaturizedinstrumentsandahigh-resolutioncameratoperformthesurgery.Robot-assistedsurgeryoffersseveraladvantagesovertraditionalopensurgery,includinggreaterprecision,increasedrangeofmotion,andimprovedvisualizationofthesurgicalsite.

Anotherminimallyinvasivesurgicaltechniquethathasgainedpopularityinrecentyearsisendoscopicsubmucosaldissection(ESD).InESD,aflexibleendoscopeisusedtoremovecanceroustissuefromtheinnerliningoftheesophagus.Thistechniqueisespeciallyusefulintreatingearly-stageesophagealcancerthathasnotspreadbeyondtheinnerliningoftheesophagus.ESDhasbeenshowntohavealowerincidenceofcomplications,shorterhospitalstays,andfasterrecoverytimescomparedtotraditionalopensurgery.

Decreasedmorbidityandfasterrecoverytimeassociatedwithminimallyinvasivesurgeryhaveledtoanimprovementinpatientqualityoflife.Patientswhoundergominimallyinvasivesurgeryreportlesspain,lessscarring,andaquickerreturn