保留迷走神经近端胃癌根治术的临床研究

Clinical study of vagus nerve preserving proximal gastrectomy for gastric cancer

目的探讨保留迷走神经近端胃癌根治术的安全性,评估其临床有效性。方法 2007年6月至2009年12月经胃镜检查病理证实的40例近端胃癌患者,随机分为三组,分别接受保留迷走神经的近端胃癌根治术(A组)、传统近端胃癌根治术(B组)和全胃切除胃癌根治术(C组)。术后1年观察并比较患者生活质量、食管黏膜改变、胆囊收缩功能。结果 40例患者均顺利完成研究,其中A组10例、B组13例、C组17例。A、B、C三组患者性别、年龄、肿瘤大小、Borrmann分型、病理分化、Lauren分型方面,无显著性差异。A、B、C三组淋巴结清扫数量分别为(28.0±2.83)、(28.46±3.75)、(29.05±5.1)枚,差异无统计学意义。术后随访1年,生活质量Spitzer评分分别为(8.1±1.1)、(7.0±1.1)、(6.9±2.9),差异无统计学意义。A、B、C三组的腹泻发生率分别为10.0%、58.3%和66.7%,A组与B、C组相比,差异有统计学意义(P=0.015)。A、B、C三组胆囊收缩功能良好比例分别为80.0%、75.0%和26.7%,A、B组功能良好比例显著高于C组,差异有统计学意义(P=0.009)。A、B两组食管黏膜改变程度Savery-Miller分类0/I级比例分别为60.0%(6/10)和16.7%(2/12),差异有统计学意义(P=0.035)。结论保留迷走神经的近端胃癌根治术在技术和临床疗效方面安全、可行,肿瘤根治程度与传统近端/全胃切除的胃癌根治术相当。

Objective To study the feasibility and safety of vagus nerve preserving proximal gastrectomy for gastric cancer , and to evaluate its clinical efficacy. Methods Forty proximal gastric cancer patients from June 2007 to June 2009 were divided randomly into three groups , and received vagus nerve preserving proximal gastrectomy (Group A,n =10),or traditional proximal gastrectomy (Group B,n=13),or total gastrectomy(Group C,n=17).After one year of follow-up,The clinicopathological data,quality of life, esophageal mucosal change , and gallbladder contraction function were observed and compared among the three groups. Results All 40 patients completed the study. There were no statistically differences in age , gender, tumor size,Borrmann types, histological types and Lauren types , among the three groups. The mean numbers of lymphe node harvested were (28.10 ±2.83) in Group A, (28.46±3.75) in Group B, and (29.05±5.10) in Group C (P>0.05). The Spitzer scores for quality of life were (8.1 ±1.1) in Group A, (7.0 ±1.1) in Group B and (6.9 ±2.9) in Group C (P >0.05). The incidence of diarrhea in group A was 10.0% , significantly lower than 58.3% in Group B and 66.7% in Group C (P =0.015). The percentage of normal gallbladder contraction was 26.7% in Group C , significantly lower than 80.0% and 75.0% in Group A and B respectively (P=0.009). The percentage of Savery-Miller 0 / I grades of esophageal mucosa change in group A was 60.0% , significantly higher than 16.7% in group B (P=0.035). Conclusions Vagus nerve preserving proximal gastrectomy for gastric cancer is technically safe and feasible , and clinically effective. It can achieve the same curative effect as traditional proximal or total gastrectomy for proximal gastric cancer.