手助腹腔镜与腹腔镜辅助SiewertⅡ型和Ⅲ型胃食管结合部腺癌根治术的比较

Objective To evaluate the clinical curative effect and prognosis of hand-assisted laparoscopic (HALS) and laparoscopic assisted surgery for Siewert Ⅱ,Ⅲ gastroesophageal junction adenocarcinoma (AEG).Methods A retrospective analysis of 105 patients with advanced Siewert type Ⅱ and Ⅲ AEG between Jan 2012 and Jan 2013 was made on the operation time,amount of blood loss,number of lymph nodes dissected,postoperative complications,postoperative hospital stay and postoperative 5-year survival rate.Results HALS resulted in significantly shorter operation time and the average postoperative hospital stay [(203±54) min比(283±72) min,t=-4.902,P=0;(10±4) d 比(13±3)d,t=-0.939,P =0.002] for advanced Siewert type Ⅱ and Ⅲ AEG.There was no conversion to open surgery in HALS group,while there was 3 cases in laparoscopy assisted surgery group (x2 =4.118,P =0.042).5 year overall survival (OS) in HALS group was 46.7％ (95％ CI39.98-53.88),and it was 60.9％ for stage Ⅱ patients 37.8％ for stage Ⅲ.5 years OS rate was not significantly different between the two groups.Conclusion HALS compared with laparoscopy assisted surgery in the treatment of advanced Siewert type Ⅱ and type Ⅲ AEG has shorter operation time,higher safety operation,shorter postoperative recovery time.The number of patients with postoperative complications and the 5-year survival rate after surgery are not significantly different between the two groups.