经腹食管裂孔入路下纵隔淋巴结清扫在食管胃结合部腺癌手术中的应用

Application of transhiatal approach for lower mediastinal lymph node dissection in surgery for adenocarcinoma of esophagogastric junction

摘要:

近年来，食管胃结合部腺癌（AEG）发病率上升，受到国际学界广泛关注。AEG的淋巴结转移具有双向性，Siewert II、III型AEG食管受侵距离>2 cm时，需进行下纵隔淋巴结清扫，AEG食管受侵距离<4 cm时，采用经腹食管裂孔入路可有效、安全地完成该手术；以心下囊为解剖标志，有助于下纵隔淋巴结的完整清扫；全系膜切除理念可以提高下纵隔淋巴结清除率，提高肿瘤学安全性。

Abstract:

The increasing incidence of adenocarcinoma of the esophagogastric junction (AEG) has gained worldwide concern in recent years. The lymph node metastasis of AEG presents bidirectional pattern. When the esophageal invasion length in Siewert II and III AEG is more than 2 cm, the lower mediastinal lymph node dissection is required; when the esophageal invasion length is less than 4 cm, the operation can be performed effectively and safely by transhiatal approach. Employing the infracardiac bursa as an anatomical landmark can help the accurate dissection of the lower mediastinal lymph nodes; the concept of total mesenteric excision can improve the clearance rate of the lower mediastinal lymph nodes and improve the oncological safety.