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目的：探讨SiewertⅡ型和Ⅲ型食管胃结合部腺癌的合理手术入路。方法回顾性分析2007年8月至2012年8月间徐州医学院附属淮安manbet官网登录 收治的135例Siewert Ⅱ～Ⅲ型食管胃结合部腺癌患者的临床资料，其中57例行经胸入路手术（经胸组），78例行经腹食管裂孔入路手术（经腹组）。比较两组患者术中淋巴结清扫、术后并发症发生及远期生存情况。结果经腹组与经胸组相比，淋巴结清扫数目增多[（11．1±0．2）枚比（10．4±0．3）枚，P＜0．05]、术后心功能不全[2．6％（2/78）比19．3％（11/57），P＜0．01]和肺功能不全[7．7％（6/78）比21．1％（12/57），P＜0．05]发生率降低，术后住院时间缩短[（13．4±0．1） d比（16．4±0．3） d，P＜0．01]；两组患者切缘阳性率[0比1．8％（1/57），P＞0．05]和吻合口瘘发生率[1．3％（1/78）比3．5％（2/57），P＞0．05]的差异无统计学意义。术后随访6～72（中位数38）月，两组患者术后5年生存率分别为34．6％和29．8％，差异无统计学意义（P＞0．05）。结论对于SiewertⅡ型和Ⅲ型食管胃结合部腺癌，经腹食管裂孔入路较经胸入路手术能获得更多的淋巴结清扫数目，而且能降低术后心肺并发症发生率，缩短住院时间。

Objective To explore the optimal surgical approach for Siewert Ⅱ and Ⅲadenocarcinoma of esophagogastric junction (AEG). Methods Clinical data of 135 patients with Siewert Ⅱand Ⅲ AEG treated in our hospital from August 2007 to August 2012 were analyzed retrospectively. Of 135 patients, 57 received transthoracic path for the stomach and proximal gastrectomy, second station lymph node resection (transthoracic group), and 78 cases received transabdominal hiatal approach (transabdominal group). The intraoperative lymph node harvested, postoperative complications and 5-year survival rate were compared between the two groups. Results There were no significant differences in the residual tumor positive margin and anastomotic leakage rate between the two groups (both P>0.05). Compared with transthoracic group, transabdominal group had more lymph node dissected (11.1±0.2 vs. 10.4±0.3, P=0.033], less postoperative cardiac[2.6%(2/78) vs. 19.3%(11/57), P<0.01] and pulmonary [7.7%(6/78) vs. 21.1%(12/57), P<0.05] morbidity, and short postoperative hospital stay[(13.4±0.1) d vs. (16.4±0.3) d, P<0.01]. A total of 128 cases were followed up for median 38 months (6 to 72 months). The 5-year survival rate in transthoracic group and transabdominal group was 29.8% and 34.6% respectively , without significant difference (P>0.05). Conclusion For the treatment of patients with Siewert Ⅱ and Ⅲ AEG, transabdominal hiatal approach can remove more lymph nodes , reduce postoperative cardiopulmonary morbidity and shorten hospital stay.