保留幽门胃切除术后的临床评估

Postoperative clinical evaluation following pylorus-preserving gastrectomy.

作者信息

Yamaguchi Tomohiro, Ichikawa Daisuke, Kurioka Hideaki, Ikoma Hisashi, Koike Hiroshi, Otsuji Eigo, Ueshima Yasuo, Shioaki Yasuhiro, Lee Chol Joo, Hamashima Takashi, Deguchi Eiichi, Ikeda Eito, Mutoh Fumitaka, Yamagishi Hisakazu

机构信息

Department of Surgery, Kyoto First Red Cross Hospital, Kyoto, Japan.

出版信息

Hepatogastroenterology. 2004 May-Jun;51(57):883-6.

PMID:15143939

Abstract

BACKGROUND/AIMS: Recent pathological study demonstrated that extended lymphadenectomy is not always necessary for patients with early gastric cancer.

METHODOLOGY

Twenty-eight patients underwent pylorus-preserving gastrectomy. The clinicopathological findings of patients with pylorus-preserving gastrectomy were compared to those of 58 patients with conventional distal gastrectomy.

RESULTS

There were no significant differences in surgical duration, blood loss, blood chemistry, food intake, and body weight loss. Regarding abdominal symptoms, early dumping syndrome was significantly higher in distal gastrectomy than in pylorus-preserving gastrectomy (35.6% vs. 12.0%, p<0.05). Remnant gastritis was also significantly higher in distal gastrectomy (57.1% vs. 27.7%, p<0.05). However, food residue tended to be more frequently seen in pylorus-preserving gastrectomy (33.3% vs. 61.1%, p=0.052). Based on questionnaire results, the rate of patient satisfaction with their surgical outcome tended to be lower in pylorus-preserving gastrectomy than in distal gastrectomy (84.0% vs. 95.6%, p=0.098). The tendency was more pronounced in patients over 70 years old (77.8% vs. 100%, p=0.065).

CONCLUSIONS

Pylorus-preserving gastrectomy is superior to conventional distal gastrectomy in the prevention of dumping syndrome and reflux gastritis. However, since delayed emptying is frequently seen post pylorus-preserving gastrectomy, this procedure is not recommended for older patients under simplistic indications.

摘要

背景/目的：近期病理学研究表明，早期胃癌患者不一定都需要进行扩大淋巴结清扫术。

方法

28例患者接受了保留幽门的胃切除术。将保留幽门胃切除术患者的临床病理结果与58例行传统远端胃切除术患者的结果进行比较。

结果

手术时间、失血量、血液生化指标、食物摄入量和体重减轻方面无显著差异。关于腹部症状，远端胃切除术后早期倾倒综合征的发生率显著高于保留幽门的胃切除术（35.6%对12.0%，p<0.05）。远端胃切除术后残胃炎的发生率也显著更高（57.1%对27.7%，p<0.05）。然而，保留幽门的胃切除术中食物残留往往更常见（33.3%对61.1%，p=0.052）。根据问卷调查结果，保留幽门的胃切除术患者对手术结果的满意度往往低于远端胃切除术（84.0%对95.6%，p=0.098）。这种趋势在70岁以上患者中更为明显（77.8%对100%，p=0.065）。