Miwa K, Kinami S, Sato T, Fujimura T, Miyazaki I
Department of Surgery II, School of Medicine, Kanazawa University, Japan.
Nihon Geka Gakkai Zasshi. 1996 Apr;97(4):286-90.
To improve quality of life in patients who had an aggressive lymph nodes dissection (D2) for early gastric carcinoma, we developed a novel procedure, nerve-saving D2 (VS-D2), in 1991. This procedure constitutes D2 and saving of hepatic and celiac branches of the vagus nerve, whereas conventional D2 consists of D2 and preserving hepatic branches alone of the vagus nerve. Thirty-nine patients between 1991 and 1994 who received VS-D2 and included 3 cases with nodal involvement had no operative death and no recurrence. The occurrence rate of postoperative diarrhea in patients with VS-D2 significantly lower than that in patients with conventional D2 (3% versus 28%, p < 0.01). Postoperative incomplete weight regain (less than 95% of preoperative weight) was also relatively lesser in patients with VS-D2 than those with conventional D2 (64% versus 84%, p = 0.08). The incidence of formation of gallstone also was relatively low in patients with VS-D2 compared that in those with conventional D2 (3% versus 13%) though the difference was not statistically significant. These results suggest that VS-D2 keeps curability of conventional D2 and improves quality of life in patients following surgery for early gastric carcinoma.
为提高早期胃癌患者接受根治性淋巴结清扫术（D2）后的生活质量，我们于1991年研发了一种新术式——保留神经的D2术（VS-D2）。该术式包括D2淋巴结清扫及保留迷走神经的肝支和腹腔支，而传统D2术仅包括D2淋巴结清扫及保留迷走神经的肝支。1991年至1994年间接受VS-D2术的39例患者（包括3例有淋巴结转移的患者）无手术死亡及复发。VS-D2术患者术后腹泻的发生率显著低于传统D2术患者（3% 对28%，p<0.01）。VS-D2术患者术后体重恢复不完全（低于术前体重的95%）的比例也低于传统D2术患者（64% 对84%，p = 0.08）。VS-D2术患者胆结石形成的发生率也低于传统D2术患者（3% 对13%），尽管差异无统计学意义。这些结果表明，VS-D2术保留了传统D2术的根治性，且提高了早期胃癌患者术后的生活质量。
