Furukawa H, Hiratsuka M, Imaoka S, Ishikawa O, Kabuto T, Sasaki Y, Kameyama M, Ohigashi H, Nakano H, Yasuda T
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan.
Ann Surg Oncol. 1998 Jun;5(4):338-41. doi: 10.1007/BF02303497.
Because there are some difficulties with the diagnosis of invasion or the endoscopic resection technique, almost all gastric tumors are resected surgically. Surgeons now are performing a limited operation for early gastric cancer of the upper stomach (EGCUS) without lymph node metastasis. This paper discusses and evaluates the surgical technique and the results of the limited operation for EGCUS.
Since 1988, a total of 34 patients with EGCUS, diagnosed as intramucosal invasion, have undergone a limited operation--fundectomy--which includes a limited proximal gastrectomy, a limited lymph node dissection, and a procedure preserving the vagal nerve. The surgical risk, postoperative complications, and survival rates of the fundectomy patients (group A) were compared with those of patients undergoing a total gastrectomy for EGCUS (group B).
Blood loss was lower in group A (300+/-193 mL) than in group B (555+/-316 mL) (P <.05). The incidence of postoperative pancreatic fistula also was lower in group A (0%) than in group B (15.0%) (P <.05). All patients in both groups (except one who died of a cerebral infarction) are alive without recurrence.
Compared to the results of a total gastrectomy, performance of a limited fundectomy for EGCUS decreased surgical risk and postoperative complications without decreasing the survival rate.
由于侵袭诊断或内镜切除技术存在一些困难，几乎所有胃肿瘤都通过手术切除。目前外科医生正在对上段早期胃癌（EGCUS）且无淋巴结转移的患者进行有限手术。本文讨论并评估了EGCUS有限手术的手术技术及结果。
自1988年以来，共有34例诊断为黏膜内侵袭的EGCUS患者接受了有限手术——胃底切除术，该手术包括有限的近端胃切除术、有限的淋巴结清扫术以及保留迷走神经的操作。将胃底切除术患者（A组）的手术风险、术后并发症及生存率与接受EGCUS全胃切除术的患者（B组）进行比较。
A组（300±193 mL）的失血量低于B组（555±316 mL）（P<.05）。A组术后胰瘘发生率（0%）也低于B组（15.0%）（P<.05）。两组所有患者（除1例死于脑梗死）均存活且无复发。
与全胃切除术的结果相比，EGCUS有限胃底切除术降低了手术风险和术后并发症，且未降低生存率。
