探讨基于CT三层四分法的经腹入路腹腔镜手术治疗II型胃食管交界肿瘤的临床价值。

回顾性分析2015年2月至2019年3月行腹腔镜手术治疗的100例CT三层四分法分型为II型胃食管交界肿瘤患者资料；根据手术入路方式不同将其分为两组，46例经胸腹入路(胸腹组)，54例经腹入路(经腹组)。术后随访截止至2020年3月，统计生存情况。选用SPSS 22.00统计软件进行数据分析，围术期各项指标等计量资料用(±s)表示，采用独立t检验；切缘阳性率、并发症发生情况等计数资料采用χ²检验。绘制生存曲线图采用Kaplan-Meier检验，P<0.05为差异有统计学意义。

两组患者均顺利完成手术，经腹组手术时间、清扫淋巴结数目、术后住院时间均明显优于胸腹组(P<0.05)；经腹组术后并发症发生率为7.4%(4/54)远小于胸腹组的23.9%(11/46)，差异有统计学意义(P<0.05)；100例患者均获得确切随访，经腹组总生存率为81.5%，胸腹组为80.4%，两组比较差异无统计学意义(P＝0.861)。

基于CT三层四分法分型为II型胃食管交界肿瘤相比于经胸腹联合入路，经腹入路腹腔镜手术安全性高，可显著缩短手术时间、住院时间，清扫更多的淋巴结，具有较高的临床价值。

To explore the clinical value of laparoscopic operation through the abdominal three-layer quadrant CT in the treatment of type II gastroesophageal junction tumors.

Retrospective analysis was conducted on the data of 100 patients with type II gastroesophageal junction tumor who underwent laparoscopic surgery from February 2015 to March 2019 and were classified by three-slice CT quartet. According to different surgical approaches, the patients were divided into two groups: 46 patients (thoracoabdominal group) and 54 patients (abdominal group). Postoperative follow-up was conducted until March 2020, and survival was counted. SPSS 22.00 statistical software was used for data analysis, measurement data of various indicators during perioperative period were expressed as (±s), the independent t test was used; The positive rate of surgical margin and the incidence of complications were counted by χ² test. Kaplan-Meier test was used to draw survival curves, and P<0.05 was considered statistically significant.

The operation was completed successfully in both groups. The operative time, number of dissected lymph nodes and postoperative hospitalization time in the transabdominal group were significantly better than those in the thoracoabdominal group (P<0.05). The incidence of postoperative complications in the transabdominal group was 7.4% (4/54), which was much lower than that in the thoraco-abdominal group (23.9%, 11/46), and the difference was statistically significant (P<0.05). All the 100 patients were followed up accurately. The overall survival rate was 81.5% in the abdominal group and 80.4% in the thoracic and abdominal group, and there was no significant difference between the two groups (P=0.861).

Compared with the transthoracic-abdominal approach, transabdominal laparoscopic surgery is safer, which can significantly shorten the operation time and hospitalization time, and remove more Lymph nodes has high clinical value.