Salo J A, Saario I, Kivilaakso E O, Lempinen M
Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.
Am J Surg. 1988 Mar;155(3):486-9. doi: 10.1016/s0002-9610(88)80119-3.
Fifty-nine consecutive patients (95 percent) with gastric cancer of the distal portion of the stomach were operated on with 95 percent subtotal gastrectomy between 1975 and 1980. The operations were for cure in all cases. Twenty-five patients were alive after 5 years, for a crude 5 year survival rate of 42 percent. The operative mortality rate was 5 percent (three patients). Twenty-four patients (41 percent) had complications, which consisted of postoperative respiratory infection in 11 patients (19 percent), postoperative ileus in 4 patients (7 percent), and subphrenic abscess in 2 patients (3.4 percent). In addition, there was one wound dehiscence and one liver rupture (with fatal outcome), one deep venous thrombosis, one urinary infection, and one wound infection. Only one patient (1.7 percent) had an anastomotic leak at the gastrojejunostomy site. Seven relaparotomies (12 percent) had to be performed for complications. We have concluded that, in patients with distal gastric cancer, 95 percent subtotal gastrectomy can result in a 5 year survival rate that is comparable to that reported in the literature for total gastrectomy, and it has the advantage of a very low rate of anastomotic leakage between the minute gastric remnant and the jejunum. Therefore, 95 percent subtotal gastrectomy is recommended over total gastrectomy in the treatment of distal gastric cancer.
1975年至1980年间，连续59例（95%）胃远端胃癌患者接受了95%的胃次全切除术。所有手术均旨在治愈。25例患者术后存活5年，粗略的5年生存率为42%。手术死亡率为5%（3例患者）。24例患者（41%）出现并发症，包括11例患者（19%）术后呼吸道感染、4例患者（7%）术后肠梗阻以及2例患者（3.4%）膈下脓肿。此外，还有1例伤口裂开和1例肝破裂（导致死亡）、1例深静脉血栓形成、1例泌尿道感染以及1例伤口感染。仅1例患者（1.7%）在胃空肠吻合部位出现吻合口漏。因并发症不得不进行7次再次剖腹手术（12%）。我们得出结论，对于胃远端癌患者，95%的胃次全切除术可获得与文献报道的全胃切除术相当的5年生存率，并且具有胃小残端与空肠之间吻合口漏发生率极低的优势。因此，在治疗胃远端癌时，推荐采用95%的胃次全切除术而非全胃切除术。
