Nomura Eiji, Isozaki Hiroshi, Fujii Keizo, Toyoda Masao, Niki Masami, Sako Shozo, Mabuchi Hideaki, Nishiguchi Kanji, Tanigawa Nobuhiko
Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan.
Hepatogastroenterology. 2003 Nov-Dec;50(54):2246-50.
BACKGROUND/AIMS: We evaluated the efficacy of the following three surgical options in gastrectomy for early gastric cancer; 1) reduction of the extent of gastrectomy, 2) preservation of the vagal nerve, and 3) preservation of the pylorus.
The postoperative physical conditions of patients who had undergone 6 kinds of operating methods incorporating elements 1), 2) and 3) were compared. The efficacy of elements 1) and 3) was evaluated by comparison among a 2/3 proximal gastrectomy group (2/3-PG group, n = 5), 4/5 proximal gastrectomy group (4/5-PG group, n = 7), and total gastrectomy group (TG group, n = 12). The efficacy of elements 1), 2) and 3) was also evaluated by comparison among a pylorus-preserving gastrectomy (PPG) group with preservation of the vagal nerve (PPGV group, n = 15), 2/3 distal gastrectomy group with preservation of the vagal nerve (2/3-DGV group, n = 12), and 4/5 distal gastrectomy group without preservation of the vagal nerve (4/5-DG group, n = 15).
Body weight loss and the incidence of abdominal symptoms and anemia in the 2/3-PG group, PPGV or 2/3-DGV group were less frequent than in the TG group or 4/5-DG group. The increases in acetaminophen concentration in the 2/3-PG group, PPGV or 2/3-DGV groups, and the changes in blood sugar and insulin levels in the 2/3-PG or PPGV group were modest, while hypergastrinemia in the 2/3-PG group was remarkable. The insulinogenic index was high in the 2/3-DGV group, and the plasma cholecystokinin changes and contraction pattern of the gallbladder resembled their preoperative pattern in the PPGV and 2/3-DGV groups. These results indicated that the patients in the 2/3-PG group owed their benefits to elements 1) and 3), the 2/3-DGV group to elements 1) and 2), and the PPGV group to elements 1), 2) and 3).
Three surgical options in gastrectomy procedures for early gastric cancer, 1) reduction of the extent of gastrectomy, 2) preservation of the vagal nerve, and 3) preservation of the pylorus, were individually confirmed to have benefits for better postoperative quality of life.
背景/目的：我们评估了以下三种手术方式在早期胃癌胃切除术中的疗效：1）缩小胃切除范围；2）保留迷走神经；3）保留幽门。
比较了接受包含1）、2）和3）要素的6种手术方法的患者术后身体状况。通过比较2/3近端胃切除组（2/3-PG组，n = 5）、4/5近端胃切除组（4/5-PG组，n = 7）和全胃切除组（TG组，n = 12）来评估1）和3）要素的疗效。还通过比较保留迷走神经的保留幽门胃切除术（PPGV组，n = 15）、保留迷走神经的2/3远端胃切除组（2/3-DGV组，n = 12）和未保留迷走神经的4/5远端胃切除组（4/5-DG组，n = 15）来评估1）、2）和3）要素的疗效。
2/3-PG组、PPGV组或2/3-DGV组的体重减轻、腹部症状发生率和贫血发生率低于TG组或4/5-DG组。2/3-PG组、PPGV组或2/3-DGV组对乙酰氨基酚浓度的升高，以及2/3-PG组或PPGV组血糖和胰岛素水平的变化较小，而2/3-PG组的高胃泌素血症较为显著。2/3-DGV组的胰岛素生成指数较高，PPGV组和2/3-DGV组的血浆胆囊收缩素变化和胆囊收缩模式与术前相似。这些结果表明，2/3-PG组的患者受益于1）和3）要素，2/3-DGV组受益于1）和2）要素，PPGV组受益于1）、2）和3）要素。
早期胃癌胃切除术中的三种手术方式，即1）缩小胃切除范围、2）保留迷走神经和3）保留幽门，经单独证实对改善术后生活质量有益。
