中国胃癌保功能手术外科专家共识(2021版)  

Chinese expert consensus on function-preserving grstrectomy for gastric cancer(2021 edition)

作　　者：中华医学会外科学分会胃肠学组 中国医师协会外科医师分会肿瘤外科学组 中国医师学会外科医师分会上消化道学组 中国抗癌协会肿瘤胃肠病学分会 赵刚[2] 胡文庆 季刚 梁品 李子禹 刘凤林[7] Gastrointestinal Surgery Group,Surgery Branch,Chinese Medical Association;Oncology Surgery Group,Surgical Branch,Chinese Medical Doctor Association;Upper Gastrointestinal Group,Surgical Branch,Chinese Medical Doctor Association;Cancer Gastroenterology Society,Chinese Anticancer Association

机构地区：[1]不详 [2]上海交通大学医学院附属仁济医院 [3]山西医科大学附属长治市人民医院 [4]空军军医大学西京医院 [5]大连医科大学附属第一医院 [6]北京大学肿瘤医院 [7]上海复旦大学附属中山医院

出　　处：《中华胃肠外科杂志》2021年第5期377-382,共6页Chinese Journal of Gastrointestinal Surgery

摘　　要：随着胃癌外科的发展,在保证手术治疗效果的前提下,尽可能保留残胃功能、减少对患者术后生活质量的影响,是患者的期望和医师的追求。功能保留胃切除术(FPG)理念的出现,标志着胃癌外科的发展进入了更加个体化、精准化的时代。由于FPG尚无明确统一的定义及手术标准与规范,由中华医学会外科学分会胃肠学组牵头,联合中国医师协会外科医师分会肿瘤外科学组、中国医师学会外科医师分会上消化道学组和中国抗癌协会肿瘤胃肠病学分会组织部分专家,综合国内外文献报道,就早期胃癌保留功能手术几经讨论后达成共识。FPG的定义为:早期胃癌在保证根治性切除的前提下,缩小手术范围,合理选择重建方式,尽可能保留胃的功能。其主要术式为缩小手术范围的术式(包括保留幽门的胃切除术、节段胃切除术、胃局部切除、内镜下切除)和近端胃切除(PG)。PG手术后的消化道重建除了远端残胃与食管吻合外,近年出现的有食管-管型胃吻合、双通道吻合(DTR)、间置空肠吻合、食管残胃侧侧吻合术(SOFY吻合)及双肌瓣吻合(Kamikawa吻合)等重建方式。对于胃保功能手术后的功能评价,主要为残胃功能(包括生理通道、胃储存和初步消化-分泌)的评价、功能相关性并发症及营养状况的评价。相信本共识的出台,必将推动临床功能保护性胃手术的规范开展,促进对胃癌疾病发展规律和胃癌手术后残胃功能认知的不断深入,进一步完善胃癌保功能手术的理论基础研究。同时也相信胃癌保功能手术的适应证和手术方式也必然会不断演进、扩大和更新。With the development of surgical treatment for gastric cancer,under the premise of ensuring the effect of surgical treatment,the objectives of preserving the function of stomach,diminishing the influence of quality of life and keeping the outcome of treatment,are the expectation of patients and the goal of surgeons.The emerge of function-preserving gastrectomy(FPG)indicates that the surgical treatment of gastric cancer steps into the individualized and precision era.Because the concept and operation procedures of FPG have not achieved consensus,the Gastrointestinal Surgery Branch,Surgery Branch,Chinese Medical Association(CMA)with Chinese Society of Surgical Oncology of Chinese Medical Doctor Association(CMDA),Chinese Society of Upper Gastrointestinal Surgeon of CMDA,Stomach and Intestines Committee of Chinese Anticancer Association,convenes some experts to summarize the recent literatures and discuss to reach the consensus about the FPG in the treatment of early gastric cancer.The definition of FPG is as follows:without compromising the oncological efficacy of early gastric cancer,decrease of the operational scale,selection of optimal reconstruction procedures and preservation of the gastric function as much as possible.The most common operation methods are procedures of minimized scale(pylorus-preserving gastrectomy,segmental gastrectomy,local gastrectomy and endoscopic resection)and proximal gastrectomy(PG).Besides the anastomosis of esophagus and gastric remnants,the reconstruction method after proximal gastrectomy also includes tubular gastroesophagostomy,double tract reconstruction,Interposition jejunostomy,side to side gastroesophagostomy(SOFY),double flap gastroesophagostomy(Kamikawa anastomosis),etc.The evaluation of gastric function after FPG includes the assessment of gastric remnant function,the functional complications and the nutritional status.We believe the publication of consensus will properly popularize FPG,promote further research about the gastric cancer and function of gastric remnant,and im

关 键 词：胃肿瘤 功能保留胃切除术 共识 

分 类 号：R735.2[医药卫生—肿瘤]