保留迷走神经、幽门胃部分切除手术在早期胃体癌中的应用  

Application of pylorus-vagus-preserving gastrectomy in early gastric cancer in middle third of stomach

作　　者：胡俊峰[1] 邵钦树[1] 孙元水[1] 许晓东[1] 徐继[1] 

机构地区：[1]浙江省人民医院胃肠外科,杭州310014

出　　处：《中华医学杂志》2015年第14期1096-1099,共4页National Medical Journal of China

基　　金：浙江省自然科学基金重点项目（LZ12H16004）

摘　　要：目的探讨保留迷走神经、幽门胃部分切除手术在胃体早期癌的远期效果。方法回顾性分析了2004年1月至2009年6月在我院普外科收治的131例早期胃体癌患者，分别行PPG手术46例，DG手术85例，比较分析两组远期的主观、客观指标，以及术后2年胃镜检查结果和5年肿瘤复发及患者生存情况，评价PPG手术的效果。结果DG组术后倾倒综合征发生率（8．2％）高于PPG组（0），术后18个月DG组胆囊结石发生率高于PPG组，均P〈0．05，差异有统计学意义。术后DG组患者返流症状发生率高，而食物淤滞症状发生率低，两组差异均无统计学意义。PPG组患者术后体重、血浆白蛋白、血胆固醇等指标恢复较DG组好，但差异无统计学意义。术后2年胃镜检查发现PPG组食物潴留（31．1％）（14／45）明显高于DG组（10．8％）（9／83），P〈0．05，差异有统计学意义。术后5年肿瘤复发率：PPG组术后复发率为6．5％（3／46），DG组为8．2％（7／85），两组比较P=0．724，差异无统计学意义；PPG组的累积5年生存率为91．3％与DG组90．6％之间差异无统计学意义。结论PPG手术对于改善胃体早癌的预后、提高胃癌患者术后生活质量具有重要的意义。Objective To evaluate the long-term outcomes of pylorus-vagns-preserving partial gastreetomy for early gastric cancer in middle third of stomach. Methods Between January 2004 and June 2009,46 patients with early gastric cancer in middle third of stomach underwent pylorus-vagns-preserving partial gastrectomy （PPG） while another 85 patients had conventional distal gastrectomy （DG） . Clinicopathologic data and follow-up results of two groups were analyzed retrospectively, including the results of subjective nutritional assessments, laboratory blood biochemical data, endoscopic findings of remnant stomach and total 5-year survival rates. Results Postprandial dumping syndrome occurred in 7 patients （8.2%） in DG group while no syndrome occurred in PPG group. The incidence of gallbladder stones at 18 months after operation in DG group was higher than that in PPG group. Significant difference existed between two groups （ P 〈 0. 05 ）. Even though no significant difference existed in laboratory blood biochemical data and endoscopic findings, PPG group recovered better and regurgitation was frequently found in DG group. Food residue in gastric remnant was frequently observed in PPG （ 31.1% ） than in DG （ 10. 8% , P 〈 0. 05 ） by endoscopic findings At 2 years post-operation, the postoperative 5-year recurrence rate was 6. 5 % （2/46） in PPG group versus 8.2% （7/85） in DG group. However no significant difference existed between 2 groups （P =0. 724）. No significant difference existed between PPG group （91.3%） and DG group （90. 6% ） in overall 5-year survival rate. Conclusion For early gastric cancer in middle third of stomach, pylorus-vagns- preserving partial gastrectomy is effective in maintaining postoperative function. And it has the same postoperative survival rate as conventional distal gastrectomy.

关 键 词：早期胃癌 胃切除术 迷走神经 幽门 

分 类 号：R735.2[医药卫生—肿瘤]