Szántó I, Vörös A, Gonda G, Nagy P, Altorjay A, Banai J, Gamal E M, Cserepes E
Semmelweis Egyetem, ETK, Sebészeti Klinika, 1389 Budapest, Pf 112. Szabolcs u. 35.
Magy Seb. 2001 Jun;54(3):144-9.
Nowadays the terminology used for the definition of adenocarcinomas at the oesophagogastric junction is "cardiac carcinoma", which can be easily misunderstood. This definition of adenocarcinomas of the oesophagogastric junction does not allow correct comparison of diagnosis (endoscopic, radiological and pathologic), epidemiology and surgical therapy in national and international aspects, because different tumours can develope in the same area, and all called cardia tumors. Siewert and Stein recommended a classification to solve this problem. The classification of the tumours is morphological/topographical. Type I is adenocarcinoma of the distal part of the oesophagus. Type II is adenocarcinoma of the real cardia and type III is subcardial gastric adenocarcinoma. At classification, we always consider results of endoscopy (ortograde and retroflexed view of the oesophago-gastric junction), the x-rays of the oesophagus and stomach, findings at the operation and pathohistologic results. Between 1/1/1974 and 31/12/2000, a total number of 50,878 upper panendoscopic examinations were performed at the Endoscopic Laboratory of the Surgical Department. Adenocarcinoma of the cardia was diagnosed in 488 patients. According to the Siewert-Stein classification, type I tumour was found in 123 (25.2%), type II in 240 (49.18%), and type III was present in 125 (25.61%) patients. The importance of this classification is it enables unified pre-operative assessment and it can also help to decide the type of the surgical intervention. In our patients with type I cancer--depending of the size of the tumour--distal 2/3 oesophagectomy with the resection of the proximal lesser curve of the stomach or total gastrectomy were performed. In the first group oesophago-jejuno-gastrostomy, in case of total gastrectomy Roux-en-Y loop anastomosis was created. In patients with types II and III cancers total gastrectomy was performed. In every patient lymphadenectomy was performed. We suggest the use of this new classification in clinical, gastroenterology--with special regard to the endoscopy--and pathology.
如今，用于定义食管胃交界腺癌的术语是“贲门癌”，这很容易引起误解。这种食管胃交界腺癌的定义不利于在国家和国际层面上对诊断（内镜、放射学和病理学）、流行病学及手术治疗进行正确比较，因为同一区域可能发生不同肿瘤，且都被称为贲门肿瘤。Siewert和Stein推荐了一种分类方法来解决这个问题。肿瘤的分类是形态学/局部解剖学的。I型是食管远端腺癌。II型是真正贲门的腺癌，III型是贲门下方的胃腺癌。在分类时，我们始终会考虑内镜检查结果（食管胃交界的顺行和逆行观察）、食管和胃的X线检查、手术所见以及病理组织学结果。在1974年1月1日至2000年12月31日期间，外科内镜实验室共进行了50878例上消化道内镜检查。488例患者被诊断为贲门腺癌。根据Siewert-Stein分类，I型肿瘤有123例（25.2%），II型有240例（49.18%），III型有125例（25.61%）。这种分类的重要性在于它能实现统一的术前评估，还有助于决定手术干预的类型。对于我们的I型癌症患者，根据肿瘤大小，进行食管远端2/3切除术并切除胃近端小弯或全胃切除术。第一组进行食管空肠胃吻合术，全胃切除时则行Roux-en-Y袢吻合术。对于II型和III型癌症患者则进行全胃切除术。每位患者均进行淋巴结清扫术。我们建议在临床、胃肠病学（尤其在内镜检查方面）及病理学中使用这种新分类。
