| Objective: Siewert type Ⅱ adenocarcinoma of esophagogastric junction(AAA Ⅱ)has a special location and complicated lymph node metastasis path.At present,there are many surgical approaches to choose from,but there is no uniform standard for surgical approach and lymph node dissection.The purpose of this study is to analyze the clinical value of different lymph node dissection ranges and surgical approaches for AAA Ⅱ,and to provide a reasonable basis for the choice of treatment options.Methods: rom August 2018 to August 2019,90 patients with AAA Ⅱwho underwent surgical resection in the thoracic surgery department of the Aast Campus of Hebei Medical University were selected continuously,and their clinical data were collected,including 72 male patients(80%)and 18 female patients(20%),with the minimum age of 43 years,the maximum age of 82 years and the median age of 66 years.The patients were divided into upper abdominal single incision operation group,left thoracic single incision operation group,Ivor-Lewis operation group according to different surgical methods.Meanwhile,the thoracic and abdominal lymph nodes were divided into four partitions according to their anatomical location and difficulty of resection during operation: middle + upper mediastinum partition,lower mediastinum partition,upper gastric + upper pancreatic partition,lower gastric + hepatoduodenal partition.To analyze and compare the relevant data of lymph node metastasis rate and degree in different regions and lymph node dissection rate in different surgical methods.Results:1.The clinicopathological features in ML group,LT group and IL group were no significant difference.2.Lymph node metastasis rates and degrees: The lymph node metastasis rates of middle + upper mediastinum partition,lower mediastinum partition,upper gastric + upper pancreatic partition,lower gastric + hepatoduodenal partition were 0.0%,7.4%,63.3% and 26.5%,upper gastric + upper pancreatic partition is obviously higher than lower gastric + hepatoduodenal partition(P<0.001),lower gastric + hepatoduodenal partition is obviously higher than middle + upper mediastinal partition and lower mediastinal partition(P<0.05),and there is no significant difference between middle + upper mediastinal partition and lower mediastinal partition(P=0.295);The lymph node metastasis degrees were 0.0%,5.3%,27.4%,6.3%,upper gastric + upper pancreatic partition was significantly higher than lower mediastinal partition and lower gastric + hepatoduodenal partition(P<0.05),lower mediastinal partition and lower gastric + hepatoduodenal partition were significantly higher than middle + upper mediastinal partition(P<0.05),but there was no significant difference between lower mediastinal partition and lower gastric +hepatoduodenal partition(P=0.635).3.Lymph node dissection rates: The lymph node dissection rates of upper mediastinum in ML group,LT group and IL group were 0.0%,0.0%,90.9%,IL group was significantly higher than ML group and LT group(P<0.05);The lymph node dissection rates of lower mediastinal partition were24.0%,78.1%,81.8%,LT group and IL group were significantly higher than ML group(P<0.05),but there was no significant difference between LT group and IL group(P=0.710);The lymph node dissection rates of upper gastric +upper pancreatic partition both were 100%;The lymph node dissection rates of lower gastric + hepatoduodenal partition were 56.0%,21.9%,84.8%,ML group and IL group were significantly higher than LT group(P<0.05),there was no significant difference between ML group and IL group(P>0.102).4.Lymph node dissection number: The lymph node dissection numbers of middle + upper mediastinum partition in ML group,LT group and IL group were 0.00(0.00-0.00),0.00(0.00-0.00),4.00(2.00-6.00),IL group was significantly higher than ML and LT groups(P<0.05);The lymph node dissection numbers of lower mediastinum partition were 0.00(0.00-0.50),2.00(1.00-3.75),2.00(1.0-4.00),LT group and IL group were significantly higher than ML group(P<0.05),there was no significant difference between LT group and IL group(P=0.743);The lymph node dissection numbers of upper gastric + upper pancreatic partition were 11.00(6.00-16.00),11.50(8.00-18.75),12.0(10.0-22.50),with no statistically significant difference(P=0.063);The lymph node dissection numbers of lower gastric +hepatoduodenal partition were 7.00(4.00-10.50),0.00(0.00-1.00),8.00(4.00-12.00),ML group and IL group were significantly higher than LT group(P<0.05).5.Operation time,intraoperative blood loss and total complication rate:The operation time of ML group,LT group,IL group were 215.00(188.50-236.50)min,173.50(150.50-185.75)min,289.00(259.00-339.50)min,IL group was significantly longer than ML group(P<0.001),and ML group was significantly longer than LT group(P=0.002);The intraoperative blood loss were 150.00(100.00-225.00)ml,150.00(150.00-200.00)ml,200.00(150.00-250.00)ml,IL group was significantly more than ML group and LT group(P<0.05),but there was no significant difference between ML group and LT group(P=0.855);The total complication rates were 32.0%,15.6%,39.4%,IL group was significantly higher than LT group(P=0.014),but there was no significant difference between IL group and ML group(P=0.562).Conclusions:1.or Siewert type adenocarcinoma of esophagogastric junction,the Ⅱprobability of lymph node metastasis in the upper gastric + upper pancreatic partition,lower gastric + hepatoduodenal partition was higher than that in the lower mediastinal partition,and no lymph node metastasis was found in the middle and upper mediastinal partition.2.Ivor-Lewis operation has obvious advantages over upper abdominal single incision and left thoracic single incision operation in clearing lymph nodes of chest and abdominal cavity,but the operation time is longer,the amount of bleeding during operation is more,and the incidence of postoperative complications is higher. |
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