早期胃癌功能保留的胃外科手术进展与展望

Progress and prospects of function-preserving gastric surgeries for early gastric cancer

随着人们对早期胃癌的认识的深入,在追求肿瘤根治的同时,越来越兼顾患者的术后生活质量,功能保留的胃切除术应运而生.其应遵循以下三个基本原则:(1)尽可能多地保留残胃的体积;(2)需保留贲门或幽门的功能;(3)尽量保留迷走神经的功能.功能保留的胃切除术包括幽门保留胃切除术、联合不同重建方式的近端胃切除术、近次全胃切除术、节段胃切除术及部分胃切除术,而前哨淋巴结活检技术的临床有效性尚待于进一步证实.精准的术前诊断及定位是开展功能保留的胃切除术的前提.

With the increasing understanding of early gastric cancer, besides the pursuit of radical tumor resection, more attention is focused on patients＇ quality of life after surgery. Thus,function-preserving gastrectomies emerge.Function-preserving gastrectomies should follow the following three basic principles：（1）retaining the volume of residual stomach as much as possible;（2） retaining the function of the cardia or pylorus; and（3） retaining the function of the vagus nerve. Functionpreserving gastrectomies include pyloruspreserving gastrectomy, proximal gastrectomy combined with different reconstruction methods, near-total gastrectomy, segmental gastrectomy, and partial gastrectomy. The effectiveness of sentinel lymph node biopsy is still to be confirmed. Accurate preoperative diagnosis and localization are the precondition of function-preserving gastrectomy.