【摘 要】
：
[目的]探讨远端胃癌行保留迷走神经腹腔支胃癌根治术的临床意义.[方法]前瞻性分析大连医科大学附属第一医院胃肠外科2009年9月-2012年6月远端胃癌患者120例,按照日本第十三版胃癌规约,行根治性远端胃切除术,D2或D3淋巴结清扫,Billroth Ⅰ或Billroth Ⅱ消化道重建术,术后病理证实为T1-T2.观察组(保留迷走神经腹腔支组)60例和对照组(传统胃癌根治术组)60例,评估两组患者
【出 处】
：
第9届全国胃癌学术会议暨第二届阳光长城肿瘤学术会议
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[目的]探讨远端胃癌行保留迷走神经腹腔支胃癌根治术的临床意义.[方法]前瞻性分析大连医科大学附属第一医院胃肠外科2009年9月-2012年6月远端胃癌患者120例,按照日本第十三版胃癌规约,行根治性远端胃切除术,D2或D3淋巴结清扫,Billroth Ⅰ或Billroth Ⅱ消化道重建术,术后病理证实为T1-T2.观察组(保留迷走神经腹腔支组)60例和对照组(传统胃癌根治术组)60例,评估两组患者术后首次排气、排便时间、首次进食时间(一般以首次排气后开始少量进水并进少量不胀气流食)、进食后的不适感(饱胀、反酸、嗳气、恶心、呕吐、食欲减退等),及远期的腹泻、胆石征、倾倒综合征、反流性胃炎等指标,行术后随访,生活质量评分.[结果]保留迷走神经腹腔支组首次排气时间(86.67±12.63h)、排便时间(92.07±7.36h),首次进食时间均早于传统胃癌根治术组患者的首次排气时间(106.85±16.40h)、排便时间(121.83±10.31h).观察组患者进食不适感21.15％明显弱于对照组43.33％.观察组在术后六个月及十二个月的腹泻、倾倒综合征、反流性胃炎的发病率明显低于对照组,胆石征的发病率两组无明显区别.保留迷走神经腹腔支组患者术后的生活质量显著优于传统胃癌根治术组(p=0.0142＜0.05).[结论]保留迷走神经腹腔支的远端胃癌根治术,可促进术后早日排气排便,早日进食,减轻进食后的不适感.降低患者术后的腹泻、倾倒综合征、反流性胃炎的发病率,生活质量优于传统胃癌根治术患者.
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