食管胃结合部腺癌个体化外科治疗实践

SPractice of individualized surgical treatment for adenocarcinoma of esophagogastric junction

  • 摘要: 食管胃结合部腺癌(AEG)发病率逐年上升,其诊治跨越胸外科与普通外科,导致手术入路、淋巴结清扫与消化道重建策略存在显著差异。淋巴结清扫是AEG根治性手术的核心环节,在实现根治性切除的同时,应兼顾消化功能保留与并发症控制,合理选择消化道重建方式。笔者基于临床实践,归纳总结AEG手术范围选择和消化道重建方法,强调以食管侵犯长度≥3 cm作为经胸清扫的关键指标,并在消化道重建中优先保留胃功能,系统阐述相关临床经验。

     

    Abstract: The incidence of adenocarcinoma of esophagogastric junction (AEG) has been rising year by year. Because its management spans both thoracic and general surgery, there are notable differences in surgical approaches, the extent of lymph node dissection, and digestive tract reconstruction. Lymph node dissection is central to curative surgery for AEG. While achieving an R0 resection, surgical planning should also balance preservation of gastrointestinal function and control of complications, with judicious selection of the digestive tract reconstruction method. The authors summarize their institutional practice regarding the selection of operative extent and reconstruction for AEG. They emphasize an esophageal invasion length (EIL)≥3 cm as a key criterion for adopting a transthoracic approach with mediastinal lymph‑node dissection, and prioritize gastric function-preserving reconstruction whenever feasible, providing systematical experience.

     

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