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 Pyloric-vagus-preserving Gastrectomy in Early Gastric Cancer

作　　者：叶翔[1] Ye Xiang(Hong'an County People's Hospital,438499 Hubei,China)

机构地区：[1]红安县人民医院,湖北黄冈438499

出　　处：《哈尔滨医药》2023年第4期15-17,共3页Harbin Medical Journal

摘　　要：目的 探讨保留迷走神经、幽门胃部分切除手术在早期胃体癌中的应用效果。方法 选取120例早期胃体癌患者为研究对象,按照完全随机原则,将以上患者随机分为PPG组和DG组,其中PPG组患者手术方式选择保留迷走神经、幽门胃部分切除术,DG组患者给予传统远端胃切除术。观察比较两组患者术后返流、食物阻滞及倾倒综合征等术后并发症发生情况;且分别于术后1个月、3个月、6个月、12个月、18个月及24个月测量PPG组和DG组两组患者体重、血浆白蛋白、血胆固醇等指标恢复情况及胆结石发生情况;定期复查胃镜,观察两组患者食管炎、残胃炎及食物潴留发生情况;术后对患者进行随访,期限为5年,观察记录两组患者术后5年肿瘤复发情况及5年生存率。结果 (1)PPG组患者的返流、食物阻滞及倾倒综合征等术后并发症发生率分别为1.7%、15.3%、0.0%均显著低于DG组患者的11.5%、18.0%、8.2%,以上差异具有统计学意义(P<0.05)。(2)PPG组患者术后胆结石发生率显著低于PPG组,以上差异具有统计学意义(P<0.05)。(3)PPG组患者术后食管炎与残胃炎发生率分别为6.8%、28.9%均略低于DG组患者的8.1%、31.1%;PPG组术后食物潴留发生率8.5%、胆汁返流发生率为0.0%显著低于DG组的19.7%、8.2%,以上差异均具有统计学意义(P<0.05)。(4)DG组术后5年肿瘤复发率为6.6%,以黏膜下层癌为主,5年生存率为91.8%;PPG组术后5年肿瘤复发率为5.1%,几乎全部为黏膜下层癌,5年生存率为93.2%;但两组以上差异均无统计学意义(P肿瘤复发率=0.72,P5年生存率=0.61)。结论 保留迷走神经、幽门胃部分切除手术在早期胃体癌的临床治疗中可有效预防返流、食物阻滞及倾倒综合征等术后并发症、术后胆结石及胆汁返流的发生,在改善患者的生存质量中具有重要的临床价值。Objective To investigate the effects of Application of pyloric-vagus-preserving gastrectomy in early gastric cancer.Methods According to the principle of completely random,120 cases of early gastric cancer patients for surgical treatment in our hospital were randomly divided into DG group and PPG group.PPG group were given the pyloric-vagus-preserving gastre ctomy,and DG group were treated with conventional distal gastrectomy.To record food block and dumping syndrome and other complications occurrence of the two groups of patients after reflux;and respectively measuring body weight,serum albu-min,serum cholesterol,and other indicators of recovery and the occurrence of gall-stones of two groups of patient after 1 month,3 months,6 months,12 months,18 months and 24 months;periodic endoscopy,were observed in patients with esopha-gitis,gastritis and food residue retention occurrence;surgery after the patients were followed up for a period of five years,the two groups were observed and recorded five years after cancer recurrence and 5-year survival rate.Results①Incidence of postoperative complications of PPG group were significantly lower than DG group,and the difference above was statistically significant(P<0.05).②The incidence of gallstones with PPG group were significantly lower than DG group,and the above difference was statistically significant(P<0.05).③Postoperative residual esopha-gitis and gastritis incidence of patients PPG group were 6.8%,28.9%,which all were lower than DG group of patients(8.1%,31.1%);Food retention rate and the incidence of bile reflux of PPG group were 8.5%and 0.0%,which all was significantly lower than DG group(19.7%,8.2%),and above differences were statistically significant(P<0.05).④DG postoperative 5-year recurrence rate was 6.6%,mainly in the submucosa carcinoma,5-year survival rate was 91.8%;PPG group tumor recurrence after five years was 5.1%,almost all of the submucosa carcinoma 5-year survival rate was 93.2%;but more than two groups showed no significant difference(P=0.72 r

关 键 词：保留迷走神经 幽门胃部分切除手术 早期胃体癌 传统远端胃切除术 

分 类 号：R730.4[医药卫生—肿瘤]