微创时代Siewert Ⅱ型食管胃结合部腺癌手术治疗策略

Surgical strategies for adenocarcinoma of esophagogastric junction under the era of mini-invasive surgery

  • 摘要: 随着微创技术的不断更新和提高,腹腔镜、机器人手术在食管胃结合部腺癌(AEG)的手术治疗中明显增加。由于Siewert Ⅱ型AEG解剖的特殊性和生物学特性,目前其手术路径、切除范围、淋巴结清扫、消化道重建尚未达成共识,也是胃肠外科与胸外科争议的核心。腹腔镜微创技术可能更有利于下纵隔淋巴结清扫。新辅助化疗后AEG患者采用腹腔镜手术切除安全、可行,机器人手术可能是未来微创外科发展方向。笔者重点探讨Siewert Ⅱ型AEG的微创手术治疗策略,也期待更多针对Siewert Ⅱ型AEG外科临床研究指导手术治疗。

     

    Abstract: With the continuous update and improvement of minimally invasive techni-ques, laparoscopic and robotic surgeries have increased significantly for the surgical treatment of adenocarcinoma of esophagogastric junction (AEG). Due to the anatomical particularity and biolo-gical characteristics of Siewert type Ⅱ AEG, surgical approach, the range of resection, lymph node dissection and digestive tract reconstruction cannot be unified at present, which is also the contro-versy between gastrointestinal surgery and thoracic surgery. Laparoscopic minimally invasive techni-que may be more conducive to lower mediastinal lymph node dissection. Laparoscopic surgery of AEG after neoadjuvant chemotherapy is safe and feasible. Robotic surgery may be the direction of minimally invasive surgery in the future. The authors mainly investigate strategies of minimally invasive surgery for the surgical treatment of AEG, and look forward to more clinical trials on Siewert type Ⅱ AEG surgery to guide surgical treatment.

     

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