The incidence of adenocarcinoma of esophagogastric junction (AEG) is increasing in recent years. Its diagnosis, lymph node metastasis and digestive tract reconstruction are all different from those of upper gastric cancer. With the development of the concept of function preserving surgery for gastric cancer, the clinical application of laparoscopic proximal gastrectomy in AEG is increasing. In this kind of operation, in addition to ensuring sufficient radical cure of tumor, the short-term smooth recovery and long-term quality of life of patients are also important. The reconstruction of digestive tract after proximal stomach operation is of great significance. According to the author's own practical experience, in clinical work, the author selects different surgical resection scope and digestive tract reconstruction methods according to Siewert classification of AEG. For Siewert Ⅱ AEG, laparoscopic PG is mostly used, and laparoscopic esophageal tubular gastric side-to-side anastomosis or double channel anastomosis is mostly used for digestive tract reconstruction. It is believed that with the emergence of long-term follow-up results and the development of multicenter randomized controlled research, some controversial questions will be better answered. We should pay attention to the individual differences of patients. For different individuals, combined with the operator's experience, on the basis of ensuring the radical cure of tumor, we should adopt appropriate surgical resection scope and digestive tract reconstruction, so as to bring better long-term quality of life for patients.
食管胃结合部腺癌(AEG)近年来发病率呈逐年上升之势,其在诊断、淋巴结转移规律和消化道重建方式等均有别于胃上部癌。目前,胃癌保功能手术得到广泛关注,近端胃切除(PG)也得到越来越多的应用。除需保障充分的肿瘤根治之外,患者术后短期的顺利恢复与长期的生活质量同样重要,近端胃术后消化道重建对此具有重要意义。笔者根据自身的实践经验,在临床工作中,按照AEG的Siewert分型选择不同的手术切除范围和消化道重建方式,对于Siewert Ⅱ型AEG,多采用腹腔镜PG,消化道重建多采用腹腔镜下食管管状胃侧侧吻合或双通道吻合。相信随着长期随访结果的出现以及多中心随机对照研究的开展,一些具有争议的问题会有更好的解答。我们应当关注患者的个体化差异,针对不同个体,结合术者经验,在保证肿瘤根治的基础上,采用合适的手术切除范围和消化道重建方式,为患者带来更好的长期生活质量。.
Keywords: Adenocarcinoma of the esophagogastric junction; Digestive tract reconstruction; Laparoscopic surgery; Proximal gastrectomy.