保留贲门的胃节段切除术在早期胃癌手术中的应用  

Segmental gastrectomy with cardia preservation for early gastric cancer

作　　者：夏明杰[1] 王权[1] Xia Mingjie;Wang Quan(Department of Gastric and Colorectal Surgery,First Hospital of Jilin University,Changchun,Jilin 130021,China)

机构地区：[1]吉林大学第一医院胃结直肠外科,长春130021

出　　处：《中华胃肠外科杂志》2020年第10期931-934,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：吉林省自然科学基金(20180101120JC)。

摘　　要：胃节段切除术是指保留贲门与幽门的胃壁环周性切除的一种手术方法。由于其保留了贲门结构,因此可以减轻患者术后食管反流症状,提高生活质量,在功能保留性胃切除术中具有潜在优势。由于切除范围的局限性,该术式在日本胃癌治疗指南中被列为研究性的手术方式,尚未在临床中得到广泛开展。通常认为,胃节段切除术适用范围及手术平面应高于保留幽门胃切除术,同时,两者的概念与治疗理念也存在差异。术中保留贲门的指征,主要取决于肿瘤T分期、切缘安全距离及淋巴结转移情况。胃节段切除术中的淋巴结清扫范围、血管及迷走神经的存留等问题,目前在不同的临床研究中还存在争议,有待进一步研究,以证实其手术安全性及远期效果。Segmental gastrectomy with cardia preservation can reduce the symptoms of postoperative gastroesophageal reflux and improve the quality of life,which is potentially advantageous among function-preserving gastrectomy procedures.However,due to the limited extent of excision,this procedure is classified as an investigational treatment in the Japanese Gastric Cancer Treatment Guidelines,without wide acceptance in clinical practice.It is generally believed that the surgical indication of segmental gastrectomy is more selected compared to the pylorus-preserving gastrectomy,and there are also differences between their therapeutic goals.The indications of cardia preservation in segmental gastrectomy mainly depend on the T stage,the distance of the resection margin and the metastasis of lymph nodes.Other points of segmental gastrectomy mainly include the scope of lymphadenectomy,the preservation of blood vessels and vagal nerves,which are still controversial in different researches.High-quality evidences are needed to confirm the safety and long-term efficacy of the segmental gastrectomy.

关 键 词：胃肿瘤 早期 贲门 功能保留性胃切除术 胃节段切除术 保留幽门胃切除术 

分 类 号：R735.2[医药卫生—肿瘤]