Nomura Eiji
Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan.
Chin J Cancer Res. 2022 Dec 30;34(6):567-574. doi: 10.21147/j.issn.1000-9604.2022.06.03.
To improve the quality of surgical procedures for gastric cancer, it is essential to consider many components comprehensively, including gastric motility, small intestinal absorption, hormones that affect gastric motility and appetite, presence or absence of vagus nerve preservation, esophageal regurgitation on endoscopic findings, in addition to whether or not there is a physiological route for food passage through the duodenum. Furthermore, proper functional evaluation cannot be performed without considering the form and amount of energy in the nutritional supplement to be loaded, and the posture at the time of investigation. The results of functional evaluation vary according to the method selected from many available options, but we believe that use of the most physiologically accurate, appropriate and selectable option will enable us to arrive at the best resection/reconstruction technique. We have reported that it is important to consider the preservation of three elements when performing gastrectomy: 1) reduction of the extent of gastrectomy, 2) preservation of the pylorus, and 3) preservation of the vagus nerve; among which preservation of the remnant stomach is the most important. Furthermore, the selection of a reconstruction method that maintains secretion of hormones beneficial to gastric motility preserves the energy balance inherent in the human body, and also provides better quality of life.
为提高胃癌手术的质量，全面考虑诸多因素至关重要，包括胃动力、小肠吸收、影响胃动力和食欲的激素、是否保留迷走神经、内镜检查结果中的食管反流，以及食物是否有通过十二指肠的生理通道。此外，若不考虑拟补充营养物质的形式和能量含量以及检查时的体位，就无法进行恰当的功能评估。功能评估结果会因从众多可用选项中选择的方法而异，但我们认为，采用最符合生理、恰当且可选择的选项将使我们能够得出最佳的切除/重建技术。我们曾报道，进行胃切除术时考虑保留三个要素很重要：1）减少胃切除范围，2）保留幽门，3）保留迷走神经；其中保留残胃最为重要。此外，选择能维持对胃动力有益的激素分泌的重建方法，可保持人体固有的能量平衡，还能提供更好的生活质量。
