Department of Gastroenterologic Surgery, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
Surg Today. 2010 May;40(5):398-403. doi: 10.1007/s00595-009-4151-1. Epub 2010 Apr 28.
Segmental resection of the stomach was first described at the end of the 19th century by Mikulicz, who devised it to preserve the pylorus when performing gastric ulcer surgery. Although this technique was abandoned because of delayed gastric emptying, in 1967 Maki et al. developed a new improved concept of segmental gastrectomy: pylorus-preserving gastrectomy (PPG). The dramatic decrease in the occurrence of gastric ulcers limited the opportunity to perform these operations; however, PPG was then used for treating early gastric cancer, the incidence of which has increased remarkably over the last two decades. From the viewpoint of surgical oncology, a rationale to justify reducing the range of lymphadenectomy is required for preserving the curability. Therefore, we devised a new technique of transectional gastrectomy using sentinel node navigation for early gastric cancer located in the middle third of the stomach. The results of a questionnaire about postoperative symptoms and endoscopic assessment indicated the superiority of transectional gastrectomy over conventional distal gastrectomy. Future confirmation of the sentinel node concept through a multi-institutional validation study conducted by the Japanese Society of Sentinel Node Navigation Surgery would lead to widespread adoption of transectional gastrectomy.
胃的节段切除术最初由 Mikulicz 在 19 世纪末描述，他在进行胃溃疡手术时设计了这种手术来保留幽门。尽管由于胃排空延迟，这种技术被放弃了，但在 1967 年，Maki 等人提出了节段胃切除术的新概念：保留幽门的胃切除术（PPG）。胃溃发生率的急剧下降限制了这些手术的机会；然而，PPG 随后被用于治疗早期胃癌，过去二十年来，早期胃癌的发病率显著增加。从肿瘤外科学的角度来看，需要保留可治愈性来证明减少淋巴结清扫范围的合理性。因此，我们设计了一种新的用于治疗位于胃中三分之一的早期胃癌的使用前哨淋巴结导航的横断性胃切除术技术。关于术后症状和内镜评估的问卷调查结果表明，横断性胃切除术优于传统的远端胃切除术。通过日本前哨淋巴结导航手术学会进行的多机构验证研究对前哨淋巴结概念的未来确认将导致广泛采用横断性胃切除术。
