保留幽门胃切除术与节段性胃切除术的概念及手术原则辨析  

Pylorus-preserving gastrectomy and segmental gastrectomy: discrimination of concepts and surgical procedures

作　　者：夏明杰[1] 王权[1] Xia Mingjie;Wang Quan(Department of Gastric and Colorectal Surgery,The First Hospital,Jilin University,Changchun 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》2021年第5期454-457,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：吉林省自然科学基金(20180101120JC)。

摘　　要：保留幽门胃切除术与节段性胃切除术都是通过胃壁的环周切除,从而实现贲门与幽门结构的保留,均属于功能保留胃切除术范畴,但两种手术方式概念与手术原则存在显著区别。节段性胃切除术适用手术平面应高于保留幽门胃切除术。保留幽门胃切除术作为早期胃癌的标准手术方式之一,其淋巴结清扫范围(No.1、3、4sb、4d、6、7、8a、9)、术中幽门下区血管以及迷走神经肝支、幽门支保留方式已形成广泛共识。节段性胃切除术目前仅作为一种研究性手术方式,其手术原则目前尚无统一标准,在临床中开展应充分重视其潜在伦理风险。临床上准确理解两种手术方式的概念与手术原则差异,将有助于后续相关临床研究工作的开展与准确评价。Both pylorus-preserving gastrectomy(PPG)and segmental gastrectomy(SG)achieve the preservation of gastric cardia and pylorus through the circumferential resection of stomach,while concepts and surgical procedures of these two operations are obviously different.In this sense,transectional gastrectomy includes both PPG and SG.PPG is one of the standard surgical procedure for early gastric cancer(EGC).The extent of lymph node dissection(No.1,3,4sb,4d,6,7,8a,9)and the retention of infrapyloric vessels,hepatic and pyloric branch of vagal nerve has formed a consensus.Meanwhile,SG is regarded as an investigational treatment according to the Japanese gastric cancer treatment guidelines.It is still controversial and may generate an ethical risk in the clinical practice.This article distinguishes the difference in the concepts and surgical procedures between PPG and SG,assisting a comprehensive evaluation in further research.

关 键 词：胃肿瘤 早期 保留功能胃切除术 节段性胃切除术 保留幽门胃切除术 贲门 

分 类 号：R735.2[医药卫生—肿瘤]