胃癌手术中保留大网膜的争议与共识  

Controversy and consensus on preservation of greater omentum in radical gastrectomy

作　　者：戴可帆 臧潞[1] DAI Ke-fan;ZANG Lu(Department of General Surgery,Rui Jin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai Minimally Invasive Surgery Center,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院普通外科上海市微创外科临床医学中心,上海200025

出　　处：《中国实用外科杂志》2022年第8期879-884,共6页Chinese Journal of Practical Surgery

基　　金：上海市卫生健康委先进适宜技术推广项目(No.2019SY030)。

摘　　要：大网膜是胃癌腹膜转移的常见部位,为减少术后复发及潜在转移风险,大网膜切除通常作为胃癌根治术的组成部分。然而,大网膜在限制腹腔感染扩散、参与腹膜免疫和减少术后并发症等方面具有重要作用,完全切除大网膜的影响不可小觑。临床上,关于切除大网膜是否能改善病人预后仍存在争议。当前研究结果表明,预防性切除大网膜并不能给早期和进展期胃癌病人带来额外的生存获益,而保留大网膜则可显著缩短手术时间、减少术中失血并降低术后并发症发生率,尤其在腹腔镜手术中。因此,在胃癌手术中是否需要预防性切除大网膜仍有待商榷,保留大网膜或将成为未来胃癌根治术的主流趋势。大网膜是切除还是保留,仍需大规模临床随机对照试验加以验证。The greater omentum is a common site of peritoneal metastasis of gastric cancer. In order to reduce the risk of recurrence and potential metastasis, omentectomy is considered to be an essential part of radical gastrectomy.However, the greater omentum plays an important role in limiting the spread of intra-abdominal infection, participating in peritoneal immunity, and reducing postoperative complications. Careful consideration should be given to the resection of the greater omentum. Clinically, it is still controversial whether omentectomy improves the prognosis of patients. Current studies have shown that omentectomy does not bring additional survival benefits to patients with early or even advanced gastric cancer, whereas preservation of the greater omentum can significantly shorten the operation time and reduce intraoperative blood loss and postoperative complications, especially in laparoscopic surgery. Therefore,whether prophylactic resection of greater omentum is necessary in gastric cancer surgery remains to be discussed,and the preservation of the greater omentum may become the mainstream of radical gastrectomy in the future. Resection or preservation of the greater omentum still needs to be verified by large-scale clinical randomized controlled trials.

关 键 词：胃癌 腹膜转移 大网膜 胃癌根治术 

分 类 号：R6[医药卫生—外科学]