Lu Yixun, Zhang Kecheng, Chen Lin
Department of General Surgery,the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
Department of General Surgery,the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China, Email:
Zhonghua Wei Chang Wai Ke Za Zhi. 2019 Feb 25;22(2):107-111.
The incidence of adenocarcinoma of esophagogastric junction (AEG) has been increasing. The surgical strategy for AEG remains controversial. The Siewert definition of AEG facilitates decision of surgical approach, while TNM stage for AEG contributes to prognosis evaluation and clinical decision making. Generally, transthoracic procedure is suitable for Siewert I and transhiatal is suitable for Siewert III. The lymph node drainage of AEG is characterized by simultaneous drainage to the mediastinal and abdominal lymphatic pathways. The optimal lymphadenectomy depends on the distribution of lymph node metastasis. Reconstruction of the digestive tract requires safety as a precondition, taking into account of postoperative complications and quality of life. For AEG patients undergoing total gastrectomy, Roux-en-Y anastomosis is more common. For those undergoing proximal gastrectomy, esophageal residual stomach (tubular stomach) anastomosis is more common, but the proportion of postoperative reflux esophagitis is higher. Some documents have revealed advantages of minimally invasive laparoscopic operation for AEG, but higher level evidences is needed.
食管胃交界腺癌（AEG）的发病率一直在上升。AEG的手术策略仍存在争议。AEG的Siewert定义有助于手术方式的决策，而AEG的TNM分期有助于预后评估和临床决策。一般来说，经胸手术适用于Siewert I型，经腹手术适用于Siewert III型。AEG的淋巴结引流特点是同时引流至纵隔和腹部淋巴途径。最佳的淋巴结清扫取决于淋巴结转移的分布。消化道重建以安全为前提，同时要考虑术后并发症和生活质量。对于接受全胃切除术的AEG患者，Roux-en-Y吻合术更为常见。对于接受近端胃切除术的患者，食管残胃（管状胃）吻合术更为常见，但术后反流性食管炎的比例较高。一些文献揭示了微创腹腔镜手术治疗AEG的优势，但仍需要更高水平的证据。
