全腹腔镜经腹-经膈肌入路治疗Siewert II型肿瘤：病例系列的前瞻性分析
Total laparoscopic transabdominal-transdiaphragmatic approach for treating Siewert II tumors: a prospective analysis of a case series.
作者信息
Pang Wei, Liu Gang, Zhang Yan, Huang Yun, Yuan Xinpu, Zhao Zhanwei, Zhang Chaojun
机构信息
Department of General Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, 100048, China.
Department of General Surgery, Xinan Hospital, The Third Military Medical University, Chongqing, 400037, China.
出版信息
World J Surg Oncol. 2021 Jan 23;19(1):26. doi: 10.1186/s12957-021-02136-2.
BACKGROUND
Although the morbidity of gastric cancer has decreased, the incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing. Furthermore, no consensus exists on which surgical approach should be applied for Siewert type II AEG. The purpose of our study was to evaluate the technical safety and feasibility of a new surgical approach.
METHODS
Sixty patients with Siewert type II AEG underwent laparoscopic total gastrectomy with the total laparoscopic transabdominal-transdiaphragmatic (TLTT) approach, which needs an incision in the diaphragm.
RESULTS
The median operative time, reconstruction time, and estimated blood loss were 214.8 ± 41.6 min, 29.40 ± 7.1 min, and 209.0 ± 110.3 ml, respectively. All of the patients had negative surgical margins.
CONCLUSION
There were no intraoperative complications or conversions to open surgery. Our surgical procedure provides a unique option for the safe application of laparoscopic lower mediastinal lymph node dissection and gastrointestinal reconstruction.
TRIAL REGISTRATION
Chinese Clinical Trial Registry, ChiCTR1800014336. Registered on 31 December 2017 - Prospectively registered, http://www.chictr.org.cn/edit.aspx?pid=23111&htm=4 .
背景
尽管胃癌的发病率有所下降，但食管胃交界腺癌（AEG）的发病率却在上升。此外，对于Siewert II型AEG应采用何种手术方式尚无共识。我们研究的目的是评估一种新手术方式的技术安全性和可行性。
方法
60例Siewert II型AEG患者接受了腹腔镜全胃切除术，采用全腹腔镜经腹-经膈肌（TLTT）入路，该入路需要在膈肌上做切口。
结果
中位手术时间、重建时间和估计失血量分别为214.8±41.6分钟、29.40±7.1分钟和209.0±110.3毫升。所有患者手术切缘均为阴性。
结论
无术中并发症或中转开腹手术情况。我们的手术方法为安全应用腹腔镜下纵隔淋巴结清扫和胃肠道重建提供了一种独特的选择。
试验注册
中国临床试验注册中心，ChiCTR1800014336。于2017年12月31日注册——前瞻性注册，http://www.chictr.org.cn/edit.aspx?pid=23111&htm=4 。
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