引用文本：中国抗癌协会肿瘤胃病学专业委员会. 腹腔镜经腹膈肌入路Siewert Ⅱ型食管胃结合部腺癌手术操作标准（2024版）[J/CD]. 消化肿瘤杂志(电子版), 2025, 17(1):1-8.


作者：中国抗癌协会肿瘤胃病学专业委员会

Authors: Oncology Gastroenterology Committee of China Anti-cancer Association

摘要：

随着微创手术的普及，腹腔镜经腹膈肌入路（LTP）逐渐在Siewert Ⅱ型食管胃结合部腺癌（AEG）手术中应用。该技术兼具经胸和经腹的优势，实现胸腔和腹腔联合操作，能达到淋巴结的彻底清扫和安全的食管切缘以及可靠的消化道重建，具有较好的临床应用前景。但目前，LTP手术尚无统一的操作标准，从而影响了该技术的规范化实施和进一步推广。因此，中国抗癌协会肿瘤胃病学专业委员会组织国内胃肠外科和胸外科等相关领域专家，查阅相关文献，结合临床实践，经过反复讨论，制定了LTP手术操作标准，从手术路径、适应证、禁忌证、术前准备、操作流程（包括麻醉、患者体位、术者站位、腹部操作孔布局、胸腔操作孔布局、“五步法”下纵隔淋巴结清扫术和消化道重建）以及特殊并发症的预防和处理等方面进行了规范，旨在为临床医生开展LTP的Siewert Ⅱ型AEG根治术提供参考。

关键词：食管胃结合部腺癌；Siewert Ⅱ型；腹腔镜经腹膈肌入路；操作标准

Abstract：

In recent years, with the popularization of minimally invasive surgery, laparoscopic transphrenic approach (LTP) surgery for Siewert Type Ⅱ adenocarcinoma of esophagogastric junction (AEG) has gradually been applied in clinical practice. This technique combines the advantages of transthoracic and transabdominal approaches, achieving a combined operation of the thoracic and abdominal cavities. It can achieve thorough lymph node dissection, safe esophageal resection margin, and reliable digestive tract reconstruction, and has promising application prospects. However, there is no unified standard for LTP surgery at present, which hinders the standardization and further promotion of this technology. Therefore, the Oncology Gastroenterology Committee of China Anti-cancer Association has convened experts from domestic gastrointestinal and thoracic surgery fields, reviewed relevant literatures, and combined with clinical practice. After extensive discussions, they formulated the LTP surgical operation standard. This standard encompasses various aspects, including the surgical approach, indications, contraindications, preoperative preparation, operational procedures (encompassing anesthesia, patient positioning, surgeon's stance, abdominal operation port layout, thoracic operation port layout, the Five-Step Maneuver lower mediastinal lymphadenectomy, and digestive tract reconstruction), as well as the prevention and management of specific complications. The aim is to provide a reference for clinical doctors conducting the Siewert Type Ⅱ AEG radical surgery with LTP.

Key Words:  Adenocarcinoma of esophagogastric junction; Siewert Type Ⅱ; Laparoscopic transphrenic approach; Criteria

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