He Z P, Wang Y Y, Su S, Zhang K, Guan X Q, Mei X H, Guo W
Department of Surgery, Changzhi Medical College,Changzhi 046000, China.
Department of Gastrointestinal Surgery, Heji Hospital Affiliated to Changzhi Medical College, Changzhi 046000, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2023 Feb 25;26(2):202-206. doi: 10.3760/cma.j.cn441530-20220430-00192.
With the gradual increase in the diagnosis rate of early gastric cancer, clinicians must consider prevention of gastric anatomical structure and physiological function while ensuring the radical treatment of the tumor. Pylorus-preserving gastrectomy is a function- preserving operation that preserves the pylorus, inferior pyloric vessel, and the vagus nerve in patients with early middle gastric cancer. One of the major controversies at present is the thoroughness of limited lymph node dissection for pyloric-preserving gastrectomy. Various studies have reported that the lymph node metastasis rate of early middle gastric cancer was low, especially in the suprapyloric region, inferior pylorus and the upper pancreatic region. Partial lymph node dissection is required for vascular and neurological protection, which is also safe and feasible in studies reported by major centers. Many clinical studies have been carried out in Japan and Korea, and postoperative follow-up has gradually increased evidence, providing the basis for the safety of lymph node dissection. In large case studies comparing pylorus- preserving gastrectomy with traditional distal gastrectomy, the incidence of postoperative morbidity, such as dumping syndrome, bile reflux esophagitis, weight loss, and malnutrition is low. Sentinel lymph node navigation technology is gradually applied to the diagnosis and treatment of early gastric cancer, and its clinical application value still needs further research.
随着早期胃癌诊断率的逐渐提高，临床医生在确保肿瘤根治性治疗的同时，必须考虑保留胃的解剖结构和生理功能。保留幽门胃切除术是一种保留功能的手术，适用于中早期胃癌患者，可保留幽门、幽门下血管及迷走神经。目前主要的争议之一是保留幽门胃切除术的有限淋巴结清扫的彻底性。多项研究报道，中早期胃癌的淋巴结转移率较低，尤其是在幽门上区、幽门下区及胰上区。为保护血管和神经需要进行部分淋巴结清扫，这在各大中心报道的研究中也是安全可行的。日本和韩国开展了许多临床研究，术后随访逐渐增加了证据，为淋巴结清扫的安全性提供了依据。在比较保留幽门胃切除术与传统远端胃切除术的大型病例研究中，术后倾倒综合征、胆汁反流性食管炎、体重减轻和营养不良等并发症的发生率较低。前哨淋巴结导航技术逐渐应用于早期胃癌的诊断和治疗，其临床应用价值仍需进一步研究。
