早期胃癌微创治疗进展

Progress in minimally invasive treatment of early gastric cancer

近年来,随着我国癌症早筛政策的推广和人民健康体检意识的提高,早期胃癌的比例在不断提高,其微创化治疗方式也逐渐受到重视。早期胃癌的手术治疗先后经历了传统开腹手术、腹腔镜手术、内镜手术、双镜联合手术等发展阶段,正在朝着更加微创精准的治疗方向发展。目前,对于淋巴结转移风险较低的早期胃癌,推荐进行内镜下治疗,包括内镜下黏膜切除术和内镜下黏膜剥离术。而对于存在一定淋巴结转移风险的早期胃癌,目前指南推荐行腹腔镜D1/D1+/D2根治术。近年来,大量研究聚焦于探索进一步优化早期胃癌微创治疗的新术式,比如双镜联合精准确定原发灶范围并保留更多胃壁正常组织,从而避免消化道重建;前哨淋巴结示踪及活检技术减少淋巴结清扫范围等。在本文中,笔者通过查阅国内外相关指南及文献,并结合临床实践经验,对早期胃癌微创治疗的发展历程、现状及前景进行探讨。

In recent years,with thepromotion of China'scancer early screening policy and the improvement of people's awareness of health examination,the proportion of early gastric cancer is increasing,and its minimally invasive treatment methods have gradually received attention.The surgical treatment of early gastric cancer has successively undergone the development stages of traditional laparotomy,laparoscopic surgery,endoscopic surgery,and double-mirror combined surgery,and is developing towards more minimally invasive and precise treatment.Currently,endoscopic treatment is recommended for early-stage gastric cancer with a low risk of lymph node metastasis,including endoscopic mucosal resection and endoscopic submucosal dissection.For early-stage gastric cancer with a certain risk of lymph node metastasis,the current guidelines recommend laparoscopic D1/D1+/D2 radical resection.In recent years,a large number of studies have focused on exploring new techniques to further improve the minimally invasive treatment of early gastric cancer,such as double mirroring to accurately determine the scope of the primary lesion and preserve more normal tissue of the stomach wall,so as to avoid digestive tract reconstruction.Sentinel lymph node tracing and biopsy techniques reduce the scope of lymph node dissection.In this paper,the author discusses the development,status quo and prospect of minimally invasive treatment of early gastric cancer by reviewing relevant guidelines and literature at home and abroad,and combining clinical practice experience.