Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
J Surg Res. 2019 Oct;242:214-222. doi: 10.1016/j.jss.2019.04.024. Epub 2019 May 13.
Combination laparoscopic lymph node (LN) dissection and endoscopic resection is a promising treatment for early gastric cancer. However, LN dissection could cause nerve injury and deterioration of motility in the preserved stomach. This experimental study aims to evaluate changes in gastric motility after tailored perigastric regional lymph node dissection without gastrectomy.
We identified four most frequently involved LN combinations considering tumor location from retrospective reviews of 4697 gastrectomy patients. We randomly assigned 55 dogs to five groups: control (laparotomy only) and four experimental groups with LN dissection without gastrectomy: group 1 (LNs 3, 7, and 8), group 2 (LNs 3, 4, and 6), group 3 (LNs 1, 3, and 7), and group 4 (LNs 3, 4, and 11). Gastric emptying time (GET) was measured using barium-impregnated polyethylene spheres. GET and GET were the time points when 50% and 75% of the markers, respectively, had emptied from the stomach.
On postoperative days (PODs) 2 and 3, GET GET and proportion of GET <4 h in groups 1 and 2 were comparable with controls. However, group 3 showed delayed GET and GET, and groups 3 and 4 demonstrated significantly smaller proportions of GET <4 h compared with controls on PODs 2 and 3. This effect resolved by POD 6 and there were no significant differences in GET GET or proportion of GET <4 h between the groups.
Tailored perigastric LN resection without gastrectomy was feasible and acceptable in terms of postoperative motility in the preserved stomach.
腹腔镜下淋巴结清扫术（LN）联合内镜切除术是治疗早期胃癌的一种有前途的方法。然而，LN 清扫术可能导致保留胃的神经损伤和运动功能恶化。本实验研究旨在评估不进行胃切除的胃周区域淋巴结清扫术对胃动力的影响。
我们从 4697 例胃癌患者的回顾性研究中，考虑肿瘤位置，确定了四个最常涉及的 LN 组合。我们将 55 只狗随机分为五组：对照组（仅剖腹术）和四个无胃切除术的 LN 清扫实验组：组 1（LN3、7 和 8）、组 2（LN3、4 和 6）、组 3（LN1、3 和 7）和组 4（LN3、4 和 11）。使用钡浸渍聚乙烯球测量胃排空时间（GET）。GET 和 GET 分别是标记物 50%和 75%从胃排空的时间点。
术后第 2 和第 3 天，组 1 和 2 的 GET GET 和 GET<4h 的比例与对照组相似。然而，组 3 显示出延迟的 GET 和 GET，并且组 3 和 4 与对照组相比，在术后第 2 和第 3 天，GET<4h 的比例显著较小。这种影响在术后第 6 天得到缓解，并且在 GET GET 和 GET<4h 的比例方面，各组之间没有显著差异。
不进行胃切除的个体化胃周 LN 切除术在保留胃的术后运动方面是可行和可接受的。
