目的 探讨完全胸腔镜联合腹腔镜施行微创Sweet食管切除术治疗早中期SiewertⅡ型食管胃交界腺癌的可行性、安全性和近期疗效.方法 回顾性分析2013年10月至2015年6月于安徽医科大学附属省立医院胸外科接受Sweet食管切除术的122例早中期SiewertⅡ型食管胃交界腺癌患者.男性87例,女性35例.年龄48 ～ 78岁,中位年龄67岁.其中47例接受微创手术,75例接受传统左开胸开放手术.术后病理分期Ⅰa期16例,Ⅰb期35例,Ⅱa期32例,Ⅱb期28例,Ⅲa期11例.采用t检验和X2检验比较两组患者临床病理特征、术中情况和术后并发症发生率.结果 两组患者在性别、年龄、术前合并症、术前美国麻醉师协会分级和术前临床分期方面差异无统计学意义,临床资料具有可比性.两组患者术后临床病理特征和手术时间差异无统计学意义.微创组淋巴结清扫枚数及站数优于开放组[(18.1±2.7)枚比(15.0±2.5)枚,t=6.612,P＝0.001;(8.9±1.1)站比(6.7±1.2)站,t＝ 9.960,P=0.003],术中出血量低于开放组[(88 ±32)ml比(120±34) ml,t=5.052,P=0.001],胸腔引流管留置时间低于开放组[(8±4)d比(10±4)d,t=3.110,P=0.002],术后住院日低于开放组[(9±5)d比(12±4)d,t＝3.167,P=0.002].两组患者术后在院病死率、总并发症发生率差异无统计学意义(P＞0.05).微创组肺部并发症发生率低于开放组(8.5％比22.7％,X2 =4.063,P=0.044).结论 完全胸腔镜联合腹腔镜施行微创Sweet食管切除术治疗早中期SiewertⅡ型食管胃交界腺癌安全可行,该术式肿瘤学切除范围优于传统左胸开放手术,可获得满意的近期疗效.%Objective To describe the technique for minimally invasive Sweet esophagectomy and to evaluate the feasibility,safety and the short-term clinical outcomes of this approach in the treatment of Siewert type Ⅱ esophagogastric junction adenocarcinoma.Methods The clinical data of 122 patients with Siewert type Ⅱ csophagogastric junction adenocarcinoma who received Sweet esophagectomy between October 2013 and June 2015 in Department of Thoracic Surgery,Auhui Provincial Hospital Affiliated with Anhui Medical University was analyzed retrospectively.The study group consisted of 87 men and 35 women,and the ages ranged from 48 to 78 years (median:67 years).Of those 122 patients,47 underwent minimally invasive approach and 75 underwent open left transthoracic sweet esophagectomy.This study included16 stage Ⅰa patients,35 stage Ⅰb patients,32 stage Ⅱ a patients,28 stage Ⅲ b patients,and 11 stage]Ⅲa patients.The clinicopathologic factors,operational factors and postoperative complications of the two groups were compared by t test and X2 test.Results The two groups were similar in terms of gender,age,American Society of Anesthesiologists grade,preoperative staging and incidence of comorbidities (P ＞0.05).The minimally invasive approach was associated with significant increase in the number of total lymph nodes dissected or the stations of the total lymph nodes dissected (1 8.1 ± 2.7 vs.15.0 ± 2.5,t =6.612,P =0.001;8.9 ± 1.1 vs.6.7 ± 1.2,t =9.960,P =0.003),significant decrease in surgical blood loss ((88 ±32) ml vs.(120 ±34) ml,t =5.052,P =0.001),chest tube duration ((8 ±4) d vs.(10 ±4) d,t=3.110,P=0.002) and postoperative stay ((9 ±5) d vs.(12 ±4) d,t=3.167,P=0.002)relative to the open approach.The postoperative in-hospital mortality and total morbidity did not differ between the two groups (P ＞ 0.05).The minimally invasive approach was associated with significantly fewer respiratory complications than the open approach (8.5％ vs.22.7％,X2 =4.063,P =0.044).Conclusion Minimally invasive technique for Siewert type Ⅱ esophagogastric junction adenocarcinoma can be safely and effectively performed for intrathoracic anastomosis with favorable early outcomes.
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