目的

探讨胸腹腔镜联合食管残胃胸内吻合手术治疗SiewertⅡ型食管胃结合部腺癌（AEG）的近期疗效。

方法

回顾性分析2021年6月至2023年4月33例SiewertⅡ型食管胃结合部腺癌患者的临床资料。采用SPSS25.0统计学软件进行数据分析。围手术期指标、胃食管反流病（GERD）量表评分等计量资料以（±s）表示，行配对t检验；术后并发症分级采用Clavien-Dindo 分级系统评估，计数资料采用［例（%）］表示。P＜0.05为差异有统计学意义。

结果

33例患者均完成胸腹腔镜联合食管残胃胸内吻合术。手术时间（262.3±37.3）min，术中出血量（178.8±111.8）ml，术后住院时间（11.4±3.6）d。2（6.1%）例患者术后发生吻合口漏，1（3.0%）例患者术后发生肺部感染，均为Clavien-DindoⅡ级，经抗炎、营养等对症支持治疗后治愈。所有患者术后切缘均为阴性，无吻合口狭窄，无吻合口出血及死亡。

结论

胸腹腔镜联合食管残胃胸内吻合手术在SiewertⅡ型AEG的治疗中安全可行，不会增加术后并发症的发生风险。

Objective

To explore the short-term efficacy of thoracoscopic and laparoscopic combined with intrathoracic anastomosis of the esophagus and residual stomach in the treatment of Siewert type Ⅱ adenocarcinoma of the esophagogastric junction （AEG）.

Methods

The clinical data of 33 patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction from June 2021 to April 2023 were retrospectively analyzed.The statistical software SPSS25.0 was used for data analysis.Measurement data such as perioperative indexes and the scores of gastroesophageal reflux disease （GERD） scale were expressed as（±s），and paired t test was performed.The postoperative complication grading was evaluated using the Clavien-Dindo grading system，and the counting data were expressed as［ cases （%）］.A P value less than 0.05 was considered statistically significant.

Results

All 33 patients completed the thoracoscopic and laparoscopic combined with intrathoracic anastomosis of the esophagus and residual stomach.The operation time was （262.3±37.3）minutes，the intraoperative blood loss was （178.8±111.8） ml，and the postoperative hospital stay was （11.4±3.6）days.Anastomotic leakage occurred in 2 （6.1%） patients and pulmonary infection occurred in 1 （3.0%） patient after surgery，both of which were Clavien-Dindo grade Ⅱ，and they were cured after symptomatic supportive treatments such as anti-inflammatory and nutritional treatments.All patients had negative surgical margins postoperatively，without anastomotic stricture，anastomotic bleeding or death.

Conclusion

Thoracoscopic and laparoscopic combined with intrathoracic anastomosis of the esophagus and residual stomach is safe and feasible in the treatment of Siewert type Ⅱ AEG，and it will not increase the risk of postoperative complications.