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中华胸部外科电子杂志 ›› 2023, Vol. 10 ›› Issue (02) : 111 -116. doi: 10.3877/cma.j.issn.2095-8773.2023.02.08

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新辅助治疗后胸腹腔镜下Ivor-Lewis食管胃结合部腺癌根治术1例并文献复习
贾卓奇, 李硕, 陈健, 张广健(), 付军科   
  1. 710061 西安,西安交通大学第一附属医院胸外科
  • 收稿日期:2022-11-29 修回日期:2022-12-29 接受日期:2023-02-08 出版日期:2023-05-28
  • 通信作者: 张广健

Thoracoscopic-laparoscopic Ivor-Lewis AEG resection after induction therapy— a case report and literature review

Zhuoqi Jia, Shuo Li, Jian Chen   

  • Received:2022-11-29 Revised:2022-12-29 Accepted:2023-02-08 Published:2023-05-28
引用本文:

贾卓奇, 李硕, 陈健, 张广健, 付军科. 新辅助治疗后胸腹腔镜下Ivor-Lewis食管胃结合部腺癌根治术1例并文献复习[J/OL]. 中华胸部外科电子杂志, 2023, 10(02): 111-116.

Zhuoqi Jia, Shuo Li, Jian Chen. Thoracoscopic-laparoscopic Ivor-Lewis AEG resection after induction therapy— a case report and literature review[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2023, 10(02): 111-116.

食管癌是世界范围内最常见的癌症死亡原因之一,根据最近的癌症统计数据[1],其发病率排名第七,总死亡率排名第六。根据病理类型的不同,食管癌分为食管鳞癌(esophageal squamous cell carcinoma,ESCC)和食管胃结合部腺癌(adenocarcinoma of esophagogastric junction,AEG)。近年来2种类型在全球的发病率均逐渐升高。Siewert分型仍是普遍使用的分型方式,对手术入路有较好的指导价值,但对于Ⅱ型AEG的手术方式、切除范围、淋巴清扫范围、消化道重建方式以及微创技术应用等,不同中心的经验不同,争议和分歧较大[2]

图1 上消化道造影(2020年9月):食管胃结合部肿物累及食管下段及胃小弯,造影剂通过充盈缺损
图2 治疗前后胸上腹增强CT对比。A:新辅助治疗前胸上腹增强CT(2020年9月):食管胃结合部肿瘤,侵及胃小弯及食管下段>3 cm,腹腔干及胃左动脉淋巴结肿大融合成团;B:新辅助治疗后胸上腹增强CT(2020年11月):食管胃结合部肿瘤明显退缩,腹腔干融合淋巴结较前明显缩小
图3 超声胃镜(2020年11月):贲门右前壁黏膜粗糙隆起,食管下段及胃小弯病变明显缩小
图4 术后病理未见肿瘤组织残留,间质纤维组织增生、组织细胞反应(HE,×40)
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