中国胃癌保功能手术外科专家共识(2025版)  

Chinese expert consensus on function‐preserving gastrectomy for gastric cancer(2025 edition)

作　　者：中华医学会外科学分会胃肠外科学组 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病学分会 中国抗癌协会胃癌专业委员会 刘凤林 李子禹 练磊 卫勃[5] 季刚 王桂华 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;Gastric Cancer Committee of the Chinese Anticancer Association;Liu Fenglin(不详;the Second Department of Gastric Surgery,Fudan University Changhai Cancer Hospital,Shanghai 200032,China)

机构地区：[1]不详 [2]复旦大学附属肿瘤医院胃外二科,上海200032 [3]北京大学肿瘤医院 [4]中山大学附属第六医院 [5]解放军总医院 [6]空军军医大学西京医院 [7]华中科技大学同济医学院附属同济医院

出　　处：《中华胃肠外科杂志》2025年第2期109-120,共12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以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。《中国胃癌保功能手术外科专家共识(2021版)》首次在国内系统性地对FPG进行了定义、适应证及手术方式等方面的阐释。近年来,随着以功能可视化、淋巴结示踪、血管导航以及影像多组学人工智能(AI)等为代表的胃癌外科技术的快速进展,FPG的理念和实践也在不断演进。鉴于此,由中华医学会外科学分会胃肠外科学组牵头,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、中国抗癌协会肿瘤胃病学分会和中国抗癌协会胃癌专业委员会组织部分专家,综合国内外文献报道,结合近年来的相关研究和临床实践,进一步更新完善了该共识。FPG的定义仍沿用2021版共识中的表述,即: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、胃局部切除和内镜下切除)、近端胃切除(PG)和保留迷走神经的远端胃切除术。PG手术后的消化道重建除了远端残胃与食管吻合、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)外,近年来又兴起一批抗反流的新型术式,如管型胃"程式Giraffe吻合"、改良SOFY吻合、单肌瓣吻合、拱桥式吻合和隧道式吻合等。对于FPG术后的功能评价,主要为残胃功能评价、功能相关性并发症以及术后营养状况及生活质量的评价。相信本共识的更新将有助于FPG的规范化开展,为胃癌患者提供更加个体化的外科治疗�With the advancement of surgical treatment for gastric cancer surgery,the preservation of gastric function to reduce the post-operative impacts on patients' quality of life,while ensuring effective surgical outcomes, have become both patients' expectations and the pursuitof surgeons. The emergence of the concept of function-preserving gastrectomy (FPG) marks theentry of surgical treatment of gastric cancer into a more personalized and precise era. The "Chineseexpert consensus on function ‐ preserving gastrectomy for gastric cancer(2021 edition)" was thefirst systematic effort to define FPG, outlining its indications and surgical approaches. In recentyears, with the rapid development of surgical technologies, such as functional visualization, lymphnode tracing, vascular navigation, and multi-omics imaging artificial intelligence (AI), the conceptand practice of FPG have continued to evolve. Therefore, led by the the Gastrointestinal SurgeryBranch, Surgery Branch, Chinese Medical Association (CMA) with Chinese Society of SurgicalOncology of Chinese Medical Doctor Association (CMDA), Chinese Society of Upper GastrointestinalSurgeon of CMDA, Stomach and Intestines Committee of Chinese Anticancer Association, and theGastric Cancer Committee of the Chinese Anticancer Association, a group of experts has cometogether to update and refine the consensus based on domestic and international literature, as wellas recent researches and clinical practice. The definition of FPG remains consistent with the 2021edition, emphasizing the goal of achieving radical resection for early gastric cancer while minimizingthe scope of surgery, selecting appropriate reconstruction methods, and preserving as much gastricfunction as possible. The main surgical techniques include those that reduce the extent of surgery(such as pylorus-preserving gastrectomy, segmental gastrectomy, local gastric resection, andendoscopic resection), proximal gastrectomy (PG), and distal gastrectomy with vagus nervepreservation. After PG, the surgical reconstruct

关 键 词：胃肿瘤 功能保留胃切除术 专家共识 

分 类 号：R735.2[医药卫生—肿瘤]