保留幽门的胃切除术在早期胃癌外科治疗中的应用及相关指南共识解读

Application of pylorus⁃preserving gastrectomy in surgical treatment for early gastric cancer and interpretation of guidelines and consensus

目前早期胃癌的治疗以内镜下切除和腹腔镜手术为主要方式。对于不符合内镜切除适应证的病人,需接受标准的胃切除术和根治性淋巴结清扫,但这会造成术后功能障碍,严重降低生活质量。保留幽门的胃切除术(pylorus-preserving gastrectomy, PPG)是一种治疗早期胃癌并保留胃功能的手术,其在短期并发症发生方面与根治性手术相当,对长期的营养状态及生活质量有积极作用。在回顾性匹配队列研究中PPG与远端胃大部切除有相似的5年生存率,但胃延迟排空是PPG术后短期和长期出现的共性问题。PPG淋巴结清扫范围有限导致预后的不确定性,所以未广泛应用,前哨淋巴结引导手术可能为病人提供更个性化、微创的手术,从而最大限度地保留胃功能。

Endoscopic resection(ER)and laparoscopic surgery are the main methods for treatment of early gastric cancer(EGC).Radical gastrectomy(RG)and lymph node dissection are required for the patients who don’t meet the indications of ER,but it may cause postoperative stomach dysfunction and reduce quality of life(QOL).Pylorus-preserving gastrectomy(PPG)is one of the function-preserving gastrectomy for EGC.The short-term complications of PPG are equal to that of RG and it is also beneficial to long-term nutritional status and QOL.The 5-year survival rate of PPG is similar to that of distal subtotal gastrectomy(DSG)according to a retrospective study of the matched cohort.But delayed gastric emptying(DGE)is a common problem in the short and long term after PPG.The limited lymph node dissection of PPG makes its application not widely promoted.Sentinel node navigation surgery(SNNS)may provide more personalized and minimally invasive surgery,in order to preserve the gastric function to the maximum extent.