Hotta T, Taniguchi K, Kobayashi Y, Johata K, Sahara M, Naka T, Terashita S, Yokoyama S, Matsuyama K
Department of Surgery, Wakayama Rosai Hospital, Koya, Japan.
Surg Today. 2001;31(9):774-9. doi: 10.1007/s005950170046.
We evaluated postoperative function in 98 patients who underwent surgery for early gastric cancer between 1995 and 1998 to compare the results of pylorus-preserving procedures to those of conventional distal gastrectomy with Billroth I (B-I). The pylorus-preserving procedures included endoscopic mucosal resection (EMR), performed in 12 patients; local resection (Local), performed in 14 patients; segmental resection (Seg), performed in 8 patients; and pylorus-preserving gastrectomy (PPG), performed in 19 patients. B-I was performed in 45 patients. The nutritional status and serum albumin (Alb) levels after PPG, the hemoglobin (Hb) levels after EMR, Local, and PPG, and the present/preoperative body weight ratios after EMR, Local, Seg, and PPG were superior to those after B-I. The time before oral intake was recommenced after EMR and Local, the volume of oral intake tolerated after EMR, Local, Seg, and PPG, and the postoperative hospital stay after EMR were all superior to those after B-I. Moreover, significantly fewer patients suffered reflux symptoms after EMR, Local, and PPG, abdominal fullness after EMR, and early dumping syndrome after EMR, Local, and PPG than after B-I. There was also less evidence of gastritis after EMR, Local, and PPG, and of bile reflux after EMR, Local, and PPG, than after B-I. These findings indicate that pylorus-preserving procedures may result in a better postoperative quality of life for selected patients with early gastric cancer.
我们评估了1995年至1998年间接受早期胃癌手术的98例患者的术后功能，以比较保留幽门手术与传统毕Ⅰ式远端胃切除术（B-I）的结果。保留幽门手术包括12例患者接受的内镜黏膜切除术（EMR）；14例患者接受的局部切除术（Local）；8例患者接受的节段性切除术（Seg）；以及19例患者接受的保留幽门胃切除术（PPG）。45例患者接受了B-I手术。PPG术后的营养状况和血清白蛋白（Alb）水平、EMR、Local和PPG术后的血红蛋白（Hb）水平，以及EMR、Local、Seg和PPG术后的当前/术前体重比均优于B-I术后。EMR和Local术后恢复经口进食的时间、EMR、Local、Seg和PPG术后耐受的经口摄入量，以及EMR术后的住院时间均优于B-I术后。此外，与B-I术后相比，接受EMR、Local和PPG术后出现反流症状、EMR术后出现腹部饱胀感以及EMR、Local和PPG术后出现早期倾倒综合征的患者明显减少。与B-I术后相比，EMR、Local和PPG术后胃炎和胆汁反流的证据也更少。这些发现表明，对于部分早期胃癌患者，保留幽门手术可能会带来更好的术后生活质量。
