胃癌手术后的功能和营养结局。
Functional and nutritional outcomes after gastric cancer surgery.
作者信息
Tsujiura Masahiro, Nunobe Souya
机构信息
Department of Surgery, Saiseikai Shiga Hospital, Ritto City, Japan.
Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ward, Tokyo, Japan.
出版信息
Transl Gastroenterol Hepatol. 2020 Apr 5;5:29. doi: 10.21037/tgh.2019.11.10. eCollection 2020.
Recent improvements in diagnostic techniques and national screening programs have resulted in increasing number of patients diagnosed with early gastric cancer (EGC). The low incidence rate of lymph node metastasis and excellent survival rates after surgical treatment for EGC enabled the reduction in the extent of lymphadenectomy and the range of gastric resection for function-preserving gastrectomy. Thus, the quality of life (QOL) of patients with gastric cancer (GC) in the curative stage can be maintained. Moreover, these function-preserving procedures have been widely performed by less invasive procedures, such as laparoscopic and robotic approaches. Pylorus-preserving gastrectomy (PPG) and proximal gastrectomy (PG) represent the two main function-preserving surgical procedures for GC. PPG is an alternative to distal gastrectomy (DG) for cT1 N0 EGC located in the middle part of the stomach. Preservation of the pyloric function is expected to prevent post-gastrectomy syndromes such as dumping syndrome. PG is an alternative to total gastrectomy (TG) and can thus be performed for cT1 N0 EGC located in the upper part of the stomach. Preservation of the residual stomach is expected to work as a reservoir for ingested food. The optimal reconstruction method after PG among the three most commonly performed procedures (esophagogastrostomy, jejunal interposition, and double-tract reconstruction) remains controversial. In addition to these three reconstruction methods, the novel double-flap technique (DFT) of esophagogastrostomy has gained attention recently because of its potential usefulness to prevent postoperative esophageal reflux. In this review article, we summarize the current evidence of PPG and PG with esophagogastrostomy by the DFT, focusing on postoperative nutrition and QOL.
诊断技术和国家筛查项目的近期改进,已导致诊断为早期胃癌(EGC)的患者数量增加。EGC淋巴结转移发生率低且手术治疗后生存率高,使得淋巴结清扫范围和胃切除范围得以缩小,从而能够进行保留功能的胃切除术。因此,可维持胃癌(GC)治愈期患者的生活质量(QOL)。此外,这些保留功能的手术已通过腹腔镜和机器人手术等微创方法广泛开展。保留幽门胃切除术(PPG)和近端胃切除术(PG)是GC的两种主要保留功能的手术方式。对于位于胃中部的cT1 N0 EGC,PPG是远端胃切除术(DG)的替代方案。保留幽门功能有望预防诸如倾倒综合征等胃切除术后综合征。PG是全胃切除术(TG)的替代方案,因此可用于位于胃上部的cT1 N0 EGC。保留残余胃有望作为摄入食物的储存器。在三种最常用的手术方式(食管胃吻合术、空肠间置术和双通道重建术)中,PG术后的最佳重建方法仍存在争议。除了这三种重建方法外,食管胃吻合术的新型双瓣技术(DFT)最近因其预防术后食管反流的潜在效用而受到关注。在这篇综述文章中,我们总结了采用DFT进行食管胃吻合术的PPG和PG的当前证据,重点关注术后营养和QOL。