Department of Surgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pu Jian Road, Shanghai, 200127, China.
Gastric Cancer. 2021 Jan;24(1):232-244. doi: 10.1007/s10120-020-01106-z. Epub 2020 Jul 23.
Injury to the vagus nerve has been proposed to be associated with occurrence of gallstones after gastrectomy. We investigated the effect of preservation of hepatic branch of the vagus nerve on prevention of gallstones during laparoscopic distal (LDG) and pylorus-preserving gastrectomy (LPPG).
Preservation of the vagus nerve was reviewed of cT1N0M0 gastric cancer patients underwent LDG (n = 323) and LPPG (n = 144) during 2016-2017. Presence of gallstones was evaluated by ultrasonography (US) and computed tomography (CT). Incidences of gallstones were compared between the nerve preserved (h-DG, h-PPG) group and sacrificed (s-DG, s-PPG) group. Clinicopathological features were also compared.
The 3-year cumulative incidence of gallstones was lower in the h-DG (2.7%, n = 85) than the s-DG (14.6%, n = 238) (p = 0.017) and lower in the h-PPG (1.6%, n = 123) than the s-PPG (12.9%, n = 21) (p = 0.004). Overall postoperative complication rate was similar between the h-DG and s-DG (p = 0.861) as well as between the h-PPG and s-PPG (p = 0.768). The number of retrieved lymph nodes station #1 and 3-year recurrence-free survival were not significantly different between the preserved group and sacrificed group. Injury to the vagus nerve (p = 0.001) and high body mass index (BMI) (≥ 27.5 kg/m) (p = 0.040) were found to be independent risk factors of gallstone formation in multivariate analysis.
Preservation of hepatic branch of the vagus nerve can be recommended for LDG as well as LPPG of early gastric cancer patients to reduce postoperative gallstone formation.
迷走神经损伤与胃切除术后胆石症的发生有关。我们研究了保留肝支迷走神经对预防腹腔镜远端（LDG）和保留幽门胃切除术（LPPG）后胆石症的影响。
回顾性分析 2016 年至 2017 年期间行 LDG（n=323）和 LPPG（n=144）的 cT1N0M0 胃癌患者的迷走神经保留情况。通过超声（US）和计算机断层扫描（CT）评估胆石症的存在。比较神经保留（h-DG、h-PPG）组和神经牺牲（s-DG、s-PPG）组之间胆石症的发生率。还比较了临床病理特征。
h-DG（2.7%，n=85）的 3 年累积胆石症发生率低于 s-DG（14.6%，n=238）（p=0.017），h-PPG（1.6%，n=123）的发生率低于 s-PPG（12.9%，n=21）（p=0.004）。h-DG 和 s-DG 之间（p=0.861）以及 h-PPG 和 s-PPG 之间（p=0.768）的总体术后并发症发生率相似。保留组和牺牲组的淋巴结站#1 检出数和 3 年无复发生存率无显著差异。多因素分析显示，迷走神经损伤（p=0.001）和高体重指数（BMI）（≥27.5 kg/m）（p=0.040）是胆石形成的独立危险因素。
保留肝支迷走神经可推荐用于早期胃癌患者的 LDG 和 LPPG，以减少术后胆石形成。
