Saito Takuro, Kurokawa Yukinori, Takiguchi Shuji, Mori Masaki, Doki Yuichiro
Takuro Saito, Yukinori Kurokawa, Shuji Takiguchi, Masaki Mori, Yuichiro Doki, Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan.
World J Gastroenterol. 2014 Dec 14;20(46):17297-304. doi: 10.3748/wjg.v20.i46.17297.
Recent advances in diagnostic techniques have allowed the diagnosis of gastric cancer (GC) at an early stage. Due to the low incidence of lymph node metastasis and favorable prognosis in early GC, function-preserving surgery which improves postoperative quality of life may be possible. Pylorus-preserving gastrectomy (PPG) is one such function-preserving procedure, which is expected to offer advantages with regards to dumping syndrome, bile reflux gastritis, and the frequency of flatus, although PPG may induce delayed gastric emptying. Proximal gastrectomy (PG) is another function-preserving procedure, which is thought to be advantageous in terms of decreased duodenogastric reflux and good food reservoir function in the remnant stomach, although the incidence of heartburn or gastric fullness associated with this procedure is high. However, these disadvantages may be overcome by the reconstruction method used. The other important problem after PG is remnant GC, which was reported to occur in approximately 5% of patients. Therefore, the reconstruction technique used with PG should facilitate postoperative endoscopic examinations for early detection and treatment of remnant gastric carcinoma. Oncologic safety seems to be assured in both procedures, if the preoperative diagnosis is accurate. Patient selection should be carefully considered. Although many retrospective studies have demonstrated the utility of function-preserving surgery, no consensus on whether to adopt function-preserving surgery as the standard of care has been reached. Further prospective randomized controlled trials are necessary to evaluate survival and postoperative quality of life associated with function-preserving surgery.
诊断技术的最新进展已使胃癌（GC）能够在早期被诊断出来。由于早期胃癌的淋巴结转移发生率低且预后良好，因此有可能进行保留功能的手术，从而提高术后生活质量。保留幽门胃切除术（PPG）就是这样一种保留功能的手术，尽管PPG可能会导致胃排空延迟，但在倾倒综合征、胆汁反流性胃炎和气胀频率方面有望具有优势。近端胃切除术（PG）是另一种保留功能的手术，尽管该手术相关的烧心或胃部饱胀发生率较高，但在减少十二指肠胃反流和残胃良好的食物储存功能方面被认为具有优势。然而，这些缺点可能通过所采用的重建方法得以克服。PG术后的另一个重要问题是残胃癌，据报道约5%的患者会发生。因此，PG所采用的重建技术应便于术后进行内镜检查，以便早期发现和治疗残胃癌。如果术前诊断准确，这两种手术在肿瘤学安全性方面似乎都能得到保证。应仔细考虑患者的选择。尽管许多回顾性研究已证明保留功能手术的实用性，但对于是否将保留功能手术作为标准治疗方法尚未达成共识。有必要进行进一步的前瞻性随机对照试验，以评估与保留功能手术相关的生存率和术后生活质量。
