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目的探讨腹腔镜辅助根治性全胃切除术(LATG)治疗SiewertⅡ、Ⅲ胃食管结合部腺癌(AEG)病人的临床疗效。方法回顾性分析2008年12月至2013年6月福建医科大学附属协和医院收治的418例行根治性全胃切除的SiewertⅡ、Ⅲ型AEG病人的临床资料,其中腹腔镜手术(LATG组)342例,开放手术(OTG组)76例。比较两组病人近、远期疗效。结果两组病人的一般资料及临床病理学资料对比差异均无统计学意义。与OTG组相比,LATG组术中失血少、手术时间短、进食半流质时间短及术后住院天数少,而两组并发症发生率差异无统计学意义。LATG组的3年总体存活率高于OTG组(71.1%vs.61.1%,P=0.033);分层分析显示,SiewertⅡ型中,LATG组3年总体存活率明显高于OTG组(79.5%vs.69.1%,P=0.010);而SiewertⅢ型中,两组3年总体存活率差异无统计学意义(P=0.315)。通过COX比例风险模型分析显示,手术入路、肿瘤TNM分期是影响SiewertⅡ型AEG病人预后的独立危险因素(P<0.05)。结论相较于OTG,LATG治疗SeiwertⅡ、Ⅲ型AEG具有更好的近期疗效,是一种安全、可行的术式;对于SiewertⅡ型病人,LATG总体预后更好。
Objective To investigate the clinical efficacy of laparoscopic radical total gastrectomy (LATG) in the treatment of patients with SiewertⅡ, Ⅲ gastroesophageal junction adenocarcinoma (AEG). Methods The clinical data of 418 patients with radical total gastrectomy of Siewert Ⅱ and Ⅲ AEG admitted from Union Hospital Affiliated to Fujian Medical University from December 2008 to June 2013 were retrospectively analyzed. There were 342 cases of laparoscopic surgery (LATG group) , Open surgery (OTG group) 76 cases. Comparison of two groups of patients near and long-term efficacy. Results There was no significant difference between the two groups in general information and clinical pathological data. Compared with OTG group, LATG group had less blood loss, shorter operation time, shorter half-fluid intake period and less postoperative hospital stay, but there was no significant difference in the incidence of complications among the two groups. The 3-year overall survival rate in LATG group was significantly higher than that in OTG group (71.1% vs.61.1%, P = 0.033). The stratified analysis showed that the 3-year overall survival rate in LATG group was significantly higher than that in OTG group (79.5% vs .69.1%, P = 0.010). However, there was no significant difference in the 3-year overall survival rate between the two groups (P = 0.315). COX proportional hazards model analysis showed that surgical approach and TNM staging were independent risk factors for prognosis of Siewert type AEG patients (P <0.05). Conclusion Compared with OTG, LATG treatment of Seiwert Ⅱ, Ⅲ AEG has better short-term efficacy, is a safe and feasible surgical procedures; for Siewert Ⅱ patients, LATG overall prognosis better.