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[目的]探讨不同位置手术切口对食管胃结合部腺癌术后生存率的影响以及相关切缘阳性率因素分析。[方法]对我院2004年1月～2010年2月经手术治疗的食管胃结合部腺癌患者,Siewert分型为Ⅱ型、Ⅲ型患者共196例,其中采用经胸、经腹及胸腹联合3种手术入路,并对食管切缘距肿瘤平均5.13cm,食管切缘阳性率进行比较,术后采用书信及电话随访。[结果]上切缘距离肿瘤的距离﹥7cm,切缘阳性率低于其他组别,且切缘阳性降低患者术后生存率。切口选择方式对肿瘤后淋巴组织的清除也有重要的关系。[结论]当肿瘤的恶性程度越高,其出现切缘阳性率就越高,故要根据患者实际情况进行合理的手术切口的选择以及器官的联合切除,以提高患者术后生活质量。
[Objective] To investigate the postoperative survival rate of esophagogastric junctional adenocarcinoma with different surgical incisions and the correlation analysis of the positive rate of the margins. [Methods] The patients with esophagogastric junctional adenocarcinoma who underwent surgical treatment in our hospital from January 2004 to February 2010 were enrolled in this study. There were 196 patients with type Ⅱ and type Ⅲ Siewert, including transthoracic, abdominal and thoracic abdominal Combined with three kinds of surgical approach, and the esophageal resection margin from the average tumor 5.13cm, positive rate of esophageal resection compared postal mail and telephone follow-up. [Result] The distance between the upper margin and the tumor was> 7cm, the positive rate of the margin was lower than that of the other groups, and the positive margin could reduce the postoperative survival rate. The choice of incision also has important implications for the clearance of post-tumor lymphoid tissue. [Conclusion] When the malignant degree of the tumor is higher, the positive rate of the margin of the tumor is higher. Therefore, according to the actual situation of the patient, reasonable incision selection and organ resection should be performed to improve the postoperative quality of life.