Ichikawa D, Ueshima Y, Shirono K, Kan K, Shioaki Y, Lee C J, Hamashima T, Deguchi E, Ikeda E, Mutoh F, Oka T, Kurioka H
Department of Surgery, Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan.
Hepatogastroenterology. 2001 Nov-Dec;48(42):1797-801.
BACKGROUND/AIMS: Recent advances in diagnostic techniques have led to the detection of an increasing number of early gastric cancers in the upper third of the stomach. The objective of this study was to determine the most appropriate surgical treatment for these cancers.
The clinicopathologic characteristics of 35 patients with early gastric cancer in the upper third of the stomach who underwent three different types of gastrectomies were reviewed retrospectively from hospital records between January 1992 and August 1999.
Patients undergoing limited proximal gastrectomy with esophagogastrostomy reconstruction had shorter operation times and less blood loss than those for patients undergoing total gastrectomy or proximal gastrectomy with jejunal interposition. No lymph node metastasis was identified in any of these patients. Heartburn due to reflux esophagitis was seen in a few patients of each group, but they were successfully treated by antacids. The extreme reduction in food intake volume was more frequently experienced in patients with total gastrectomy than those with both proximal gastrectomies. When mortality due to other disease was excluded, all patients survived without recurrence.
A limited proximal gastrectomy with esophagogastrostomy reconstruction decreased surgical risk and realized preservation of maximal function.
背景/目的：诊断技术的最新进展使得胃上三分之一部位早期胃癌的检出数量不断增加。本研究的目的是确定针对这些癌症最合适的手术治疗方法。
回顾性分析了1992年1月至1999年8月期间因胃上三分之一部位早期胃癌接受三种不同类型胃切除术的35例患者的临床病理特征，数据来自医院记录。
与接受全胃切除术或近端胃切除加空肠间置术的患者相比，接受近端胃次全切除加食管胃吻合重建术的患者手术时间更短，失血量更少。这些患者均未发现淋巴结转移。每组均有少数患者出现反流性食管炎引起的烧心症状，但通过使用抗酸剂成功治愈。全胃切除患者比两种近端胃切除患者更常出现食物摄入量极度减少的情况。排除因其他疾病导致的死亡后，所有患者均存活且无复发。
近端胃次全切除加食管胃吻合重建术降低了手术风险，并实现了最大功能的保留。
