Chen L, Xu X X, Lu Y X, Zhang K C
Department of General Surgery, the First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Zhonghua Wai Ke Za Zhi. 2022 Sep 1;60(9):807-812. doi: 10.3760/cma.j.cn112139-20220417-00172.
There are several controversies and issues in the surgical treatment of esophagogastric junction (AEG) currently. The Siewert classification and TNM staging system are commonly used to assist clinical decision and prognosis prediction. Generally, transthoracic procedure is more suitable for Siewert Ⅰ type and longer esophageal invasion patients, while transhiatal is more suitable for Siewert Ⅲ type patients. The optimal extent of lymph node dissection for AEG should be based on tumor location and esophageal invasion range. The extent of surgical resection and the method of digestive tract reconstruction should be based on the principle of radical resection and surgical safety, and the postoperative life quality of patients should be fully considered. Roux-en-Y anastomosis is the most common and efficient anastomosis after total gastrectomy, while double tract anastomosis is recommended by many experts after proximal gastrectomy. With the continuous advancement of minimally invasive techniques, experienced centers and teams can perform digestive tract reconstruction under total laparoscopy. In the future, more high-quality studies are expected to provide evidence-based medical evidence for AEG's surgical treatment decisions.
目前，食管胃交界部（AEG）的外科治疗存在若干争议和问题。Siewert分类法和TNM分期系统常用于辅助临床决策和预后预测。一般来说，经胸手术更适合SiewertⅠ型和食管侵犯较长的患者，而经腹手术更适合SiewertⅢ型患者。AEG的最佳淋巴结清扫范围应基于肿瘤位置和食管侵犯范围。手术切除范围和消化道重建方法应基于根治性切除和手术安全的原则，并充分考虑患者术后的生活质量。Roux-en-Y吻合术是全胃切除术后最常见且有效的吻合方式，而许多专家建议近端胃切除术后采用双通道吻合术。随着微创技术的不断进步，经验丰富的中心和团队能够在全腹腔镜下进行消化道重建。未来，预计会有更多高质量研究为AEG的外科治疗决策提供循证医学依据。
