1.Department of General Surgery, the 900th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Fuzhou 350025, China;2.Fuzong School of Clinical Medicine, Fujian Medical University, Fuzhou 350025, China;3.College of Integrated Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
背景与目的 处于食管胃交界处的Siewert Ⅱ型食管胃结合部腺癌（AEG）由于其在解剖位置上的特殊性，临床上对其最佳手术入路一直存在争议。本研究探讨术前超声内镜（EUS）下钛夹标记预判Siewert Ⅱ型AEG手术入路的应用价值，以期为临床制定安全、精准的手术方案提供帮助。方法 采用前瞻性对照研究方法，纳入中国人民解放军联勤保障部队第九〇〇医院2020年2月—2021年12月接受手术治疗的60例Siewert Ⅱ型AEG患者。将患者随机分为研究组与对照组，每组各30例。完善入院常规检查后，研究组患者在术前1 d行EUS直视下探测肿瘤纵轴最长浸润位置后，在口侧1 cm处用2枚于同一高度平面进行钛夹标记定位，并立即行腹部平片确认钛夹位置。对照组患者不做任何标记。研究组患者根据钛夹与第10胸椎位置关系决定手术入路，对照组患者根据术前常规CT、胃镜等检查决定手术入路。比较两组患者的相关临床数据。结果 两组患者的性别、年龄、体质量指数、吸烟史、饮酒史等基线资料差异无统计学意义（均P>0.05）；两组患者的手术时间、术中出血、肿瘤直径、食管切缘、住院时间、术后病理分期、肿瘤T分期及N分期差异均无统计学意义（均P>0.05）。预判手术入路与实际手术入路的符合率的分析结果显示，研究组预判手术入路与实际手术入路的符合率明显高于对照组（96.67% vs. 86.21%，P<0.001）。研究组和对照组术后总体并发症发生率分别为26.67%与30.00%，差异无统计学意义（P=0.783）。结论 术前EUS下钛夹标记操作简单、安全、可靠性强，对判断Siewert Ⅱ型AEG外科手术入路具有实际的临床应用价值。
Background and Aims Siewert Type Ⅱ adenocarcinoma of the esophagogastric junction (AEG), located at the gastroesophageal junction, has been a subject of controversy regarding the optimal surgical approach due to its unique anatomical location. This study was performed to investigate the value of preoperative endoscopic ultrasound (EUS)-guided titanium clip marking in predicting the surgical approach for Siewert type Ⅱ AEG, so as to provide assistance in developing safe and precise surgical strategies in clinical practice.Methods Using a prospective controlled study design, 60 patients with Siewert type Ⅱ AEG who underwent surgery in the 900th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force from February 2020 to December 2021 were enrolled. The patients were randomly assigned to a study group and a control group, with 30 patients in each group. After standard admission examinations, the patients in the study group underwent determination of the longest infiltrating position of the tumor along its longitudinal axis under EUS-assisted direct visualization, which was positioned by placing two titanium clips at the same height plane 1 cm beyond on the oral side The clip position was immediately confirmed by abdominal X-ray. The patients in the control group did not undergo any marking. The surgical approach for the study group was determined based on the relationship between the titanium clips and the 10th thoracic vertebra, while the surgical approach for the control group was determined based on preoperative routine examinations, such as CT and gastroscopy. Relevant clinical data were compared between the two groups.Results There were no statistically significant differences between the two groups in baseline characteristics, including gender, age, body mass index, smoking history, alcohol history (all P>0.05); there were also no statistically significant differences between the two groups in terms of surgical duration, intraoperative bleeding, tumor diameter, esophageal margin, length of hospital stay, postoperative pathological stage, tumor T stage, and N stage (all P>0.05). The analysis of the concordance between predicted and actual surgical approaches showed a significantly higher rate of concordance in the study group compared to the control group (96.67% vs. 86.21%, P<0.001). The incidence of postoperative complications in the study group and the control group was 26.67% and 30.00%, respectively, with no statistically significant difference (P=0.783).Conclusion Preoperative EUS-guided titanium clip marking is a simple, safe, and highly reliable procedure with practical clinical application value for determining the surgical approach in Siewert type Ⅱ AEG.