PPG手术治疗40例早期胃癌的诊治分析
MPNFS模式护理对早期胃癌行内镜黏膜下剥离术患者中的应用
MPNFS模式护理对早期胃癌行内镜黏膜下剥离术患者中的应用发布时间：2022-12-12T06:47:28.746Z 来源：《护理前沿》2022年24期作者：何红梅[导读] 目的探究MPNFS模式护理对早期胃癌行内镜黏膜下剥离术患者中的应用。
何红梅南方医科大学南方医院赣州医院/赣州市人民医院消化内科江西赣州 341000 摘要】目的探究MPNFS模式护理对早期胃癌行内镜黏膜下剥离术患者中的应用。
方法选择2020年1月~2021年12月于我院消化内科收治的80例早期胃癌行内镜黏膜下剥离术患者为研究对象，按随机数字表法分为观察组与对照组，各40例，对照组采用常规护理，观察组采用MPNFS模式护理，比较两组负性情绪、术后恢复情况、护理满意度。
结果干预前，两组患者的SAS、SDS评分无显著差异(P>0.05)，干预后两组患者的SAS、SDS评分均明显降低，且观察组显著低于对照组（P<0.05）；观察组的卧床时间、住院时间均显著短于对照组（P<0.05）；观察组的护理满意度显著高于对照组（P<0.05）。
结论 MPNFS模式护理对早期胃癌行内镜黏膜下剥离术患者不仅可以缓解焦虑、抑郁情况，还可改善患者术后恢复情况，提升护理满意度。
【关键词】MPNFS模式护理；内镜黏膜下剥离术；术后恢复；负性情绪胃癌是临床上比较多见的消化科恶性疾病，随着人们饮食习惯及生活方式的变化，胃癌的发病率不断升高，早发现、早诊断和早治疗可有效降低胃癌患者的病死率[1-2]。
临床主要采取内镜黏膜下剥离术对早期胃癌患者进行治疗，但术后患者由于存在应激情况，出现焦虑、抑郁等情绪，不利于患者的康复，故术后的科学护理十分重要[3]。
MPNFS模式护理干预主要包括药物治疗、心理干预、临床护理、家庭关怀与社会支持，可有效缓解患者心理应激反应[4]。
本研究将MPNFS模式护理干预应用于早期胃癌行内镜黏膜下剥离术患者中，现将结果报道如下。
PPG手术Meta分析
Meta-analysis of Pylorus-Preserving Gastrectomyfor Middle-Third Early Gastric CancerPeng Song,MD,1,*Ming Lu,MD,1,*Fuxing Pu,MD,2,*Dong Zhang,MD,1Baolin Wang,MD,1and Qinghong Zhao,MD,PhD 1AbstractBackground:Pylorus-preserving gastrectomy (PPG)has been performed to reduce postprandial symptoms forsome early gastric cancer (EGC)cases.The aim of this study was to evaluate the possible advantages after PPG for middle-third EGC in comparison with distal gastrectomy.Materials and Methods:We searched Medline,Embase,and Science Citation Index Expanded for relevant studies.Statistical analyses were conducted to calculate the summary weighted mean differences (WMDs)and odds ratios (ORs)with corresponding 95%confidence intervals (95%CIs)using random-effects models.Results:We identified 15nonrandomized controlled trials (16studies)with 1774patients,which consisted of 11studies for conventional PPG (CPPG)versus conventional distal gastrectomy (CDG)and 5studies for laparoscopy-assisted PPG (LAPPG)versus laparoscopy-assisted distal gastrectomy (LADG).Meta-analysis of CPPG versus CDG revealed that CPPG had the advantage of prevention of early dumping syndrome (OR =0.18;95%CI 0.12,0.27),gastritis (OR =0.19;95%CI 0.07,0.53),duodenal juice reflux (OR =0.20;95%CI 0.06,0.66),and regaining of weight (WMD =3.53;95%CI 2.34,4.72).However,the incidence of gastric stasis was higher in the CPPG group than in the CDG group (OR =1.70;95%CI 1.13,2.57).Meta-analysis of LAPPG versus LADG revealed that LAPPG shortened the operation time (WMD =-21.12;95%CI -31.33,-10.90)and did not increase the occurrence of postoperative complication (OR =0.72;95%CI 0.41,1.27).Conclusions:With the benefits of prevention of early dumping syndrome,duodenal juice reflux,gastritis,and regaining of weight,PPG can be an excellent option for middle-third EGC.IntroductionGastric cancer is the fourth most common cancer,being the third leading cause of cancer death in men and the fifth in women worldwide.1Gastric cancer can be classified into two types:early gastric cancer (EGC)and advanced gastric cancer.According to the Japanese Gastric Cancer As-sociation,EGC is defined as a lesion of the stomach confined to the mucosa and/or submucosa,regardless of its area or the lymph node metastatic status.2Nowadays,the number of people diagnosed with EGC is gradually increasing owing to improved medical procedures.Surgical treatment is the cor-nerstone for providing definitive treatment of this malignant disease.3,4Surgeons have been focusing on modifying the surgical technique to improve the patients’quality of life.Pylorus-preserving gastrectomy (PPG)was first developed by Maki et al.5in 1967to treat gastric ulcers.In 1991,Kodama and Koyama 6first reported the indications of PPG for middle-third EGC by analysis of the relationship between lymph node metastasis and the clinicopathologic findings.Attributing to the preservation of pyloric function,PPG was reported to be beneficial in terms of postoperative quality of life.However,in order to maintain good pyloric function,this gastrectomy required preservation of the root of the right gastric artery,the infrapyloric vessels,and the hepatic,py-loric branch of the vagus nerve.7–9Such a delicate technique may be difficult to perform laparoscopically because of limited maneuverability of the instruments.In particular,the suprapyloric lymph node (station No.5node)was not dis-sected during the procedure.10It was unclear whether PPG was beneficial to patients preoperatively diagnosed with EGC located in the middle third of the stomach.Therefore,we performed a meta-analysis to assess systematically the value of PPG for treatment of middle-third EGC.1Department of General Surgery and 2Institute of Digestive Endoscopy and Medical Center for Digestive Diseases,The Second Affiliated Hospital of Nanjing Medical University,Nanjing,China.*The first three authors contributed equally to this work.JOURNAL OF LAPAROENDOSCOPIC &ADVANCED SURGICAL TECHNIQUES Volume 24,Number 10,2014ªMary Ann Liebert,Inc.DOI:10.1089/lap.2014.0123718Materials and Methods Literature searchA comprehensive search of Medline,Embase,and Science Citation Index Expanded was carried out for all related literature published in English,including references from relevant articles.The medical subject headings and key words searched for individually and in combina-tion were as follows:‘‘pylorus-preserving gastrectomy,’’‘‘conventional pylorus-preserving gastrectomy,’’‘‘conven-tional distal gastrectomy,’’‘‘laparoscopy-assisted pylorus-preserving gastrectomy,’’and ‘‘laparoscopy-assisted distal gastrectomy.’’The last search was conducted on January 1,2014.Inclusion criteria and exclusion criteriaWe identified and screened the search findings for poten-tially eligible studies.The inclusion criteria were as follows:(1)human trials of patients with histologically confirmed gastric cancer;(2)the tumor was located in the middle or lower third of the stomach;(3)EGC (invasion depth confined to the mucosal or submucosal layer);and (4)studies with at least one of the outcomes mentioned.The exclusion criteria were as follows:(1)abstract,letters,editorials,expert opin-ions,reviews,and case reports;(2)tumor invades deeper than the submucosal layer;(3)studies without a control group;and (4)studies without available data.Data extraction and quality assessmentTwo authors (P.S.and M.L.)independently reviewed and extracted the data needed using standard forms.Disagree-ments were resolved through discussion among the authors to achieve a consensus.For the purpose of assessing quality,we use the Newcastle–Ottawa scoring system 11:having 5–9stars was defined as high quality,and having <5stars was defined as low quality.FIG.1.Flowchart of articles identified with criteria for inclusion and exclusion.CDG,conventional distal gastrectomy;CPPG,conventional pylorus-preserving gastrectomy;LADG,laparoscopy-assisted distal gastrectomy;LAPPG,laparoscopy-assisted pylorus-preserving gastrectomy;RCT,randomized controlled trial.PYLORUS-PRESERVING GASTRECTOMY AND GASTRIC CANCER719T a b l e 1.C h a r a c t e r i s t i c s o f S t u d i e s I n c l u d e d i n t h e M e t a -a n a l y s i sG r o u pR e f e r e n c e Y e a r C o u n t r yS t u d y p e r i o d D e s i g n P a t i e n t sM e a n a g e (y e a r s )F o l l o w -u p (m o n t h s )R e c o n s t r u c t i o n aP r e s e r v a t i o n o f t h e b r a n c h e s o f v a g u s n e r v e bL e n g t h o f t h e a n t r a l c u f f p r e s e r v e d (c m )b D i s s e c t i o n o f s t a t i o n N o .5n o d e bC P P G /CD GI k e g u c h i e t a l .102010J a p a n1997–2007R e t r o s p e c t i v e 31/76N A 62B IH e p a t i c ,p y l o r i c3N oP a r k e t a l .162008K o r e a 1999–2003P r o s p e c t i v e 22/1757.3/56.241B I H e p a t i c ,p y l o r i c 3N o N u n o b e e t a l .172007J a p a n1993–1999P r o s p e c t i v e 194/20356.8/58.724B I H e p a t i c ,p y l o r i c ,c e l i a c 2.5–6N oY a m a g u c h i e t a l .182004J a p a n1992–2001R e t r o s p e c t i v e 28/5861.8/62.512B IH e p a t i c ,p y l o r i c1.5N oT o m i t a e t a l .282003J a p a n 1993–1996R e t r o s p e c t i v e 10/2260.7/63.660N A N o n e p r e s e r v e d 1.5Y e s N i s h i k a w a e t a l .192002J a p a n1997–2000R e t r o s p e c t i v e 12/1257/5415/12B I H e p a t i c ,p y l o r i c ,c e l i a c 1.5N oH o t t a e t a l .202001J a p a n 1995–1998R e t r o s p e c t i v e 19/4561/616B I H e p a t i c ,p y l o r i c 1.5N o Z h a n g e t a l .211998J a p a n1993–1995R e t r o s p e c t i v e 15/2858.9/58.012B IH e p a t i c ,p y l o r i c ,c e l i a c 1.5Y e sI m a d a e t a l .221998J a p a n 1992–1996R e t r o s p e c t i v e 20/25N A 12N A H e p a t i c ,p y l o r i c 1.5N o I s o z a k i e t a l .231996J a p a n1992–1993R e t r o s p e c t i v e 15/1457.3/52.712N AH e p a t i c ,p y l o r i c ,c e l i a c 1.5N oK o d a m a e t a l .241995J a p a n1989–1991P r o s p e c t i v e 35/29N A12N AH e p a t i c ,p y l o r i c1.5N oL A P P G /L A D G S u h e t a l .292014K o r e a2003–2011R e t r o s p e c t i v e 116/17654.1/59.136N AN A N AN AT o m i k a w a e t a l .252012J a p a n2004–2007R e t r o s p e c t i v e 9/1269.2/68.739/46N AH e p a t i c ,p y l o r i c ,c e l i a c 3N AI k e g u c h i e t a l .102010J a p a n1997–2007R e t r o s p e c t i v e 15/11N A62B IH e p a t i c ,p y l o r i c3Y e sL e e e t a l .262010J a p a n 2000–2009P r o s p e c t i v e 148/305N A 35.9B I /R o u x -e n -Y N A q 4N A U r u s h i h a r a e t a l .272004J a p a n 1998–2002R e t r o s p e c t i v e 26/2668/68N AN AH e p a t i c ,p y l o r i c 3N AaT h e m e t h o d o f r e c o n s t r u c t i o n i n c o n v e n t i o n a l d i s t a l g a s t r e c t o m y (C D G )o r l a p a r o s c o p y -a s s i s t e d d i s t a l g a s t r e c t o m y (L A D G ).bO p e r a t i o n s i n c o n v e n t i o n a l p y l o r u s -p r e s e r v i n g g a s t r e c t o m y (C P P G )o r l a p a r o s c o p y -a s s i s t e d p y l o r u s -p r e s e r v i n g g a s t r e c t o m y (L A P P G ).B I ,B i l l r o t h I ;N A ,n o t a p p l i c a b l e .720Statistical analysisWeighted mean differences(WMDs)and odds ratios (ORs)with corresponding95%confidence intervals(95% CIs)were used for the analysis of continuous variables and dichotomous variables,respectively.Considering there is potentially clinical heterogeneity among the studies due to differences with respect to eligibility of population,kind of surgical procedures,different definitions of outcome pa-rameters,and differences in the perioperative or postopera-tive management,random-effect models were applied in this meta-analysis.12This model might provide an appropriate estimate of the average treatment effect even if trials are statistically heterogeneous and result in a more conservative statistical claim.Statistical heterogeneity among studies was evaluated by the chi-squared-based Q test and I2statistics, with P heterogeneity<.1regarded as statistical heterogeneity among the studies.13An I2of0%–25%indicated no hetero-geneity,25%–50%may represent low heterogeneity,50%–75%may represent moderate heterogeneity,and75%–100% was considered to represent high heterogeneity.Sensitivity analysis was conducted by sequential omission of individual studies.Egger’s test and Begg’s funnel plots were used to evaluate publication bias.14If publication bias existed,the Duval and Tweedie nonparametric‘‘trim andfill’’method was used to adjust for the bias.15All statistical analyses were carried out with Stata software(version12;StataCorp LP, College Station,TX).ResultsSearch results,study characteristics,and quality assessmentOverall,in total,402records were identified by the search strategy,of which82were considered with potential value and full text was retrieved for detailed assessment.Among these82articles,62were further excluded for the following reasons:review or editorial(n=20),without comparison (n=32),and without available data(n=10).Four articles that investigated the outcome of laparoscopy-assisted PPG (LAPPG)in comparison with open PPG were excluded. Because only one randomized controlled trial(RCT)has been published,no meta-analysis of RCTs can be per-formed,so we excluded the RCT.Finally,15non-RCTs(16 studies)10,16–29were considered suitable for meta-analysis, consisting of11studies for conventional PPG(CPPG) versus conventional distal gastrectomy(CDG)and5for LAPPG versus laparoscopy-assisted distal gastrectomy (LADG)(Fig.1).The characteristics of these16studies are summarized in Table1.There were,in total,1774subjects involved in the meta-analysis.All studies were carried out in Asia.The sample size of the included studies ranged from21to453.The number of patients who underwent PPG or LAPPG was715.The mean age of the patients in these studies varied from54to69.2years.A nine-star Newcastle–Ottawa Scale was used to assess the quality of studies(see Supplementary Table S1[Supplemen-tary Data are available online at /lap]).11 Each study had a score of q5stars(see Supplementary Table S2).CPPG versus CDGDumping syndrome.Five studies reported data on the early dumping syndrome.17,18,20,21,28The combined results showed an obvious favorable tendency for CPPG compared with CDG(OR=0.18;95%CI0.12,0.27)(Table2),and no heterogeneity was observed(I2=0.0%).Only two studies provided data on late dumping syndrome.17,21The summary results indicated that there was no statistical difference (OR=0.66;95%CI0.28,1.55)(Table2)with no heteroge-neity(I2=26.3%).Table2.Meta-analysis of Conventional Pylorus-Preserving Gastrectomy Versus Conventional Distal Gastrectomy and Laparoscopy-Assisted Pylorus-Preserving GastrectomyVersus Laparoscopy-Assisted Distal Gastrectomy for Gastric CancerHeterogeneity test Publication bias Group Observed outcomes n a WMD/OR(95%CI)Q P b I2(%)P c P d CPPG/CDG Early dumping syndrome50.18(0.12,0.27)0.39.9830.0.750.806 Late dumping syndrome20.66(0.28,1.55) 1.36.24426.3——Gastritis90.19(0.07,0.53)32.48<.00175.4.004.348Bile regurgitation60.20(0.06,0.66)15.58.00867.9.171 1.000Esophagitis50.36(0.06,2.21)12.19.01667.2.025.462Gastric stasis5 1.70(1.13,2.57) 2.95.5660.0.828 1.000Gallbladder stones50.65(0.37,1.14) 3.85.4270.0.033.462Serum albumin level40.03(–0.04,0.11) 1.63.6510.0.555 1.000Recovery body weight ratio4 3.53(2.34,4.72) 2.70.4400.0.459.734 LAPPG/LADG Operative time3-21.12(-31.3,-10.90)0.60.7390.0.080.296 All complications30.72(0.41,1.27) 3.05.21834.3.022.296Gastric stasis30.73(0.07,7.75)13.08.00184.7.942 1.000Anastomotic leak30.12(0.03,0.42)0.79.6750.0.150 1.000a Number of comparisons.b P value of Q-test for heterogeneity test.c P value of Egger’s test for publication bias.d P value of Begg’s test for publication bias.CDG,conventional distal gastrectomy;CPPG,conventional pylorus-preserving gastrectomy;LADG,laparoscopy-assisted distal gastrectomy;LAPPG,laparoscopy-assisted pylorus-preserving gastrectomy.PYLORUS-PRESERVING GASTRECTOMY AND GASTRIC CANCER721FIG.2.Conventional pylorus-preserving gastrectomy versus conventional distal gastrectomy:(A)gastritis,16–18,20–24,28(B)bile regurgitation,16,17,20–22,24and (C)esophagitis.17,18,20,21,28Pooled odds ratio (OR)with 95%confidence interval (95%CI)was calculated using the random-effects model stratified by country.(continued )722SONG ETAL.Gastritis,bile regurgitation,and esophagitis.Nine stud-ies provided data on the gastritis.16–18,20–24,28The rate of gastritis was lower for CPPG (OR =0.19;95%CI 0.07,0.53)(Table 2)with significant heterogeneity (I 2=75.4%).Six studies provided data on bile regurgitation.16,17,20–22,24The results showed that CPPG had a lower incidence of bile re-gurgitation (OR =0.20;95%CI 0.06,0.66)(Table 2),and a marked heterogeneity was observed (I 2=67.9%).Five stud-ies reported data on esophagitis.17,18,20,21,28The rate of eso-phagitis was also lower for CCPG (OR =0.36;95%CI 0.06,2.21)(Table 2)with significant heterogeneity (I 2=67.2%).Gastric stasis.Five studies 10,17,18,24,28compared thegastric stasis between CPPG and CDG groups,and the inci-dence of gastric stasis was higher in CPPG (OR =1.70;95%CI 1.13,2.57)(Table 2)with no heterogeneity (I 2=0.0%).Gallbladder stones.Five studies 16,17,23,24,28comparedthe occurrence of gallbladder stones between the two groups,and there was no significant difference among them (OR =0.65;95%CI 0.37,1.14)(Table 2)with no heteroge-neity (I 2=0.0%).Serum albumin level and recovery body weight ratio.Dataon serum albumin level was available in four studies,16,19–21and no significant difference was found (WMD =0.03;95%CI 0.04,0.11)(Table 2).Recovery body weight ratio (present body weight/preoperative weight)was reported in four studies.17,20,23,28The results were in favor of the PPG group (WMD =3.53;95%CI 2.34,4.72)(Table 2),and heteroge-neity was not observed (I 2=0.0%).LAPPG versus LADGOperative time.The duration of operative time (threestudies)25,27,29in the LAPPG group was shorter than in the LADG group (WMD =-21.12;95%CI -31.33,-10.90)(Table 2)with no heterogeneity (I 2=0.0%).Postoperative complications.Postoperative complica-tions were specified in three studies.10,26,29The rate of overall postoperative complications was lower for LAPPG versus LADG (15.1versus 19.7%;OR =0.72;95%CI 0.41,1.27)(Table 2).The level of heterogeneity was low (I 2=34.3%).Gastric stasis was found in 6.8%of the LAPPG group and in 5.4%of the LADG group.Anastomotic leak occurred in 0.7%of LAPPG group compared with 4.9%of the LADG group.Test of heterogeneityWhen comparing CPPG with CDG,we observed significant heterogeneity in the gastritis,esophagitis,and bile regurgitation complications.To explore the sources of heterogeneity,we performed subgroup analysis stratified by the length of the antral cuff preserved.Among the subgroup in which a 1.5-cm length of the antral segment was preserved,no heterogeneity was found,and the pooled ORs were 0.16(95%CI 0.08,0.29)(Fig.2A)for gastritis,0.12(95%CI 0.05,0.29)(Fig.2B)for bile regurgitation,and 0.18(95%CI 0.05,0.72)(Fig.2C)for esophagitis.The level of heterogeneity in the subgroup in which a >2.5-cm length of the antral cuff was preserved was low.Furthermore,sensitivity analysis was performed to assess the influence of each individual study on the pooled estimate.Figure 3shows that the study conducted by Nunobe et al.17FIG.2.(Continued).PYLORUS-PRESERVING GASTRECTOMY AND GASTRIC CANCER723seemed to be the most influencing single study on the overall pooled estimates.After this study was omitted,heterogeneity of gastritis,esophagitis,and bile regurgitation was not detected.Moreover,the sensitivity analysis indicated high stability of results.After that study was removed,the estimated ORs (95%CI;P value)were 0.16(0.09,0.28;P <.001)(Fig.3A)for gastritis,0.12(0.05,0.27;P <.001)(Fig.3B)for bile regurgi-tation,and 0.18(0.05,0.72;P =.015;Fig.3C)for esophagitis.Publication biasThe Begg’s funnel plot and Egger’s test were performed to provide a diagnosis of the publication bias in the availableliterature.As shown in Table 2,the results suggested that gastritis,esophagitis,and gallbladder stones in the CPPG versus CDG group had potential publication bias (for gastritis,Egger’s test =0.004,Begg’s test =0.384;for esophagitis,Eg-ger’s test =0.025,Begg’s test =0.462;for gallbladder stones,Egger’s test =0.033,Begg’s test =0.462).We further used the Duval and Tweedie ‘‘trim and fill’’method to detect and ad-justed the bias,and the results did not change.The shapes of the filled funnel plot based on random-effects meta-analytic point estimates for gastritis and esophagitis did not reveal obvious evidence of asymmetry (Fig.4A and B,respectively).However,the funnel plot for gallbladder stones seemed to indicate asymmetry (Fig.4C).FIG.3.Influence analysis of the summary odds ratio for conventional pylorus-preserving gastrectomy versus conven-tional distal gastrectomy:(A)gastritis,16–18,20–24,28(B)bile regurgitation,16,17,20–22,24and (C)esophagitis.17,18,20,21,28Meta-analysis random-effects estimates (exponential form)were used.Results were computed by omitting each study (on the left)in turn.The two ends of every broken line represent the 95%confidence interval.724SONG ETAL.DiscussionReconstructive procedures,such as Billroth-I,Billroth-II,and Roux-en-Y,have been performed commonly for pa-tients following distal gastrectomy because of their sim-plicity.However,they often caused dumping syndrome,gastritis,and bile regurgitation,which would affect the quality of life for these patients.The PPG procedure,with limited stomach resection and antral cuff preservation,is afunction-preserving surgery.Debate on improving postop-erative quality of life made the function of PPG still con-troversial.Thus,we performed this meta-analysis to evaluate the value of PPG.With the development of endo-scopic techniques,the laparoscopic approach is now being widely used with the aim of achieving minimally invasive therapy for gastric cancer.30–32So our meta-analysis con-tained five studies that compared LPPG with LADG.In this meta-analysis,it was demonstrated that CPPG has several benefits,such as the prevention of early dumping syndrome,duodenal juice reflux,gastritis,and regaining of weight compared with CDG.In addition,we found that the serum albumin level,late dumping syndrome,esophagitis,and the incidence of gallbladder stone were not different between the two groups.However,the incidence of gastric stasis after CPPG was higher than after CDG.The one RCT enrolled 36patients for PPG and 38for CDG.33It was re-ported that PPG has an advantage in terms of early dumping syndrome over CDG.No difference was found in serum al-bumin level and gallstone incidence.These results in the RCT did not conflict with those in our meta-analysis.Nevertheless,our meta-analysis,based on a comprehensive literature search,gave relatively reliable conclusions.Besides,we also evaluated more postoperative outcomes such as gastritis,bile regurgitation,esophagitis,and recovery body weight ratio.Currently,the development of endoscopy has penetrated into all areas of surgical paroscopic-assisted gas-trectomy has aroused interest among many surgeons owing to its minimal invasion and low levels of PPG versus LADG meta-analysis showed that operation time was sig-nificantly shorter in the LAPPG group,whereas postoperative complications such as gastric stasis and anastomotic leak were not different between the two groups.The length of the antral cuff preserved played an important role in investigating the postoperative evaluation.In the stratified analysis,we found that gastritis,bile regurgitation,and esophagitis occurred significantly less often after PPG than after CDG when a 1.5-cm length of the antral segment was preserved.However,there was no difference for gastritis,bile regurgitation,and esophagitis in the subgroup in which a >2.5-cm length of the antral cuff was preserved.Given that the number of studies in the subgroup having a >2.5-cm length of the antral cuff preserved was small,we should treat this finding with caution.To maintain the pyloric function,the root of the right gastric artery,the infrapyloric vessels,and the hepatic,pyloric branch of the vagus nerve were routinely preserved.6,34As a result,the station No.5lymph node was not dissected during PPG,which might be worrisome in terms of oncologic safety and lead to an increased risk of cancer recurrence and death.According to previous reports,about 10%–32%of EGC patients had mi-crometastasis.35–37When focused on the station No.5lymph node,the rate of micrometastasis might be much lower than in other reports.38Moreover,the overall 5-year survival rate of patients with EGC who undergone PPG was 96.3%.8Con-sidering the overall 5-year survival rates were 95%–100%and 85%–95%for patients with mucosal and submucosal cancer following gastrectomy,respectively,4,39the survival rate for PPG was not worse.In addition,Suh et al.29reported that the 3-year recurrence-free survival rates were 98.8%for patients who underwent LADG and 98.2%for those who underwent LAPPG,which was not significantly different.In summary,FIG. 4.Filled funnel plot based on random-effects meta-analytic point estimates for publication bias test:(A)gastritis,16–18,20–24,28(B)esophagitis,17,18,20,21,28and (C)gallbladder stones.16,17,23,24,28Each point represents a sep-arate study for the indicated association.LnOR,natural logarithm of odds ratio.PYLORUS-PRESERVING GASTRECTOMY AND GASTRIC CANCER725PPG appeared to be oncologically safe and achieved an equivalent long-term prognosis to other gastrectomies. However,the following limitations in this meta-analysis should be considered.First,we only identified one RCT,so high-quality meta-analysis of RCTs could not be performed. Second,because the operations using unified methods did not compare results during the same period and with the same surgeons,the possibility of bias could not excluded.Third, we were unable to analyze some important outcomes,in-cluding gastric emptying function and gallbladder emptying function,owing to lack of available data.Fourth,a high level of heterogeneity was detected for gastritis,bile regurgitation, and esophagitis in the CPPG versus CDG group,which may be due to the results of the study conducted by Nunobe et al.17 The study appeared to be distinguished from other studies because of the following reasons:(1)surgical procedures may be different from the others,in particular,the length of the antral cuff preserved ranged from2.5to6cm;and(2) gastritis,bile regurgitation,and esophagitis were all the en-doscopicfindings,and the criteria of this study were different than those of the other studies.40Fifth,we only evaluated perioperative or postoperative outcomes for LAPPG versus LADG because of the lack of literature regarding long-term outcomes.Finally,the total sample size was small,and all the participants came from Asia,so there was a potential publi-cation bias.Thus,more studies are needed from other racial groups to evaluate the benefits of PPG.In conclusion,PPG is a safe and feasible surgical proce-dure for middle-third EGC.In contrast,because of the limited data,we cannot consider PPG is totally better than CDG or LADG.However,with the benefits of prevention of early dumping syndrome,duodenal juice reflux,gastritis,and re-gaining of weight,PPG can be an excellent option for ex-perienced surgeons.Well-designed multicenter RCTs are still needed to confirm the benefits of PPG.Disclosure StatementNo competingfinancial interests exist.References1.Jemal A,Bray F,Center MM,et al.Global cancer statistics.CA Cancer J Clin2011;61:69–90.2.Japanese Gastric Cancer A.Japanese Classification ofGastric Carcinoma—2nd English edition.Gastric Cancer 1998;1:10–24.3.Shi Y,Zhou Y.The role of surgery in the treatment ofgastric cancer.J Surg Oncol2010;101:687–692.4.Kim HS,Kim MG,Kim BS,et al.Analysis of predictiverisk factors for postoperative complications of laparoscopy-assisted distal gastrectomy.J Laparoendosc Adv Surg Tech A2013;23:425–430.5.Maki T,Shiratori T,Hatafuku T,et al.Pylorus-preservinggastrectomy as an improved operation for gastric ulcer.Surgery1967;61:838–845.6.Kodama M,Koyama K.Indications for pylorus preservinggastrectomy for early gastric cancer located in the middle third of the stomach.World J Surg1991;15:628–633;dis-cussion633–634.7.Hiki N,Kaminishi M.Pylorus-preserving gastrectomy ingastric cancer surgery—Open and laparoscopic approaches.Langenbecks Arch Surg2005;390:442–447.8.Morita S,Katai H,Saka M,et al.Outcome of pylorus-preserving gastrectomy for early gastric cancer.Br J Surg 2008;95:1131–1135.9.Hiki N,Nunobe S,Kubota T,et al.Function-preservinggastrectomy for early gastric cancer.Ann Surg Oncol 2013;20:2683–2692.10.Ikeguchi M,Hatada T,Yamamoto M,et al.Evaluation ofa pylorus-preserving gastrectomy for patients preopera-tively diagnosed with early gastric cancer located in the middle third of the stomach.Surg Today2010;40:228–233.11.Stang A.Critical evaluation of the Newcastle-Ottawa scalefor the assessment of the quality of nonrandomized studies in meta-analyses.Eur J Epidemiol2010;25:603–605. 12.DerSimonian R,Laird N.Meta-analysis in clinical trials.Control Clin Trials1986;7:177–188.13.Higgins JP,Thompson SG.Quantifying heterogeneity in ameta-analysis.Stat Med2002;21:1539–1558.14.Egger M,Davey Smith G,Schneider M,et al.Bias in meta-analysis detected by a simple,graphical test.BMJ1997;315:629–634.15.Duval S,Tweedie R.Trim andfill:A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.Biometrics2000;56:455–463.16.Park do J,Lee HJ,Jung HC,et al.Clinical outcome ofpylorus-preserving gastrectomy in gastric cancer in com-parison with conventional distal gastrectomy with Billroth I anastomosis.World J Surg2008;32:1029–1036.17.Nunobe S,Sasako M,Saka M,et al.Symptom evaluationof long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer.Gastric Cancer2007;10:167–172.18.Yamaguchi T,Ichikawa D,Kurioka H,et al.Postoperativeclinical evaluation following pylorus-preserving gastrec-tomy.Hepatogastroenterology2004;51:883–886.19.Nishikawa K,Kawahara H,Yumiba T,et al.Functionalcharacteristics of the pylorus in patients undergoing pylo-rus—Preserving gastrectomy for early gastric cancer.Sur-gery2002;131:613–624.20.Hotta T,Taniguchi K,Kobayashi Y,et al.Postoperativeevaluation of pylorus-preserving procedures compared with conventional distal gastrectomy for early gastric cancer.Surg Today2001;31:774–779.21.Zhang D,Shimoyama S,Kaminishi M.Feasibility of pylorus-preserving gastrectomy with a wider scope of lymphade-nectomy.Arch Surg1998;133:993–997.22.Imada T,Rino Y,Takahashi M,et al.Postoperative func-tional evaluation of pylorus-preserving gastrectomy for early gastric cancer compared with conventional distal gastrectomy.Surgery1998;123:165–170.23.Isozaki H,Okajima K,Momura E,et al.Postoperativeevaluation of pylorus-preserving gastrectomy for early gastric cancer.Br J Surg1996;83:266–269.24.Kodama M,Koyama K,Chida T,et al.Early postoperativeevaluation of pylorus-preserving gastrectomy for gastric cancer.World J Surg1995;19:456–460;discussion461.25.Tomikawa M,Korenaga D,Akahoshi T,et al.Quality oflife after laparoscopy-assisted pylorus-preserving gastrec-tomy:An evaluation using a questionnaire mailed to the patients.Surg Today2012;42:625–632.26.Lee SW,Nomura E,Bouras G,et al.Long-term oncologicoutcomes from laparoscopic gastrectomy for gastric cancer:A single-center experience of601consecutive resections.JAm Coll Surg2010;211:33–40.726SONG ET AL.。
早期胃癌临床诊治思路分析
早期胃癌临床诊治思路分析早期胃癌（early gastric cancer，EGC）是指癌细胞仅限于黏膜及黏膜下层，判断标准不是看是否有局部淋巴结转移，最为关键是看癌细胞浸润深度。
EGC的病理分型有Ⅰ型(隆起型)，II型（浅表型）和III型（凹陷型），其中II 型又分为三个亚型，II a(表浅隆起型)、IIb（表浅平坦型）、和IIc（表浅凹陷型）。
由于其早期无明显临床症状，易被忽视，逐渐发展成进展期胃癌，因此，早期发现、早期诊断、早期治疗是提高胃癌患者生存率的根本。
1 资料与方法1.1 资料收集2005年1月至2009年1月我院胃镜室活检发现，手术及病理证实的60例患者。
其中，男性41例，女性19例。
年龄在34—75岁，临床表现无特异性，主要为腹胀嗳气15例，上腹部隐痛不适22例，恶心呕吐纳差16例，贫血、黑便7例。
详细分析每例患者的临床表现，内镜下病变的部位、大小，活检的病理分析和术后的标本病理特征，淋巴结转移的情况等指标。
60例早期胃癌患者病变部位胃镜下分类（例%）ⅠII aIIbIIcII a+IIbIIc+IIIIII6（10.0）2（3.0）9（15.0）6（10）18（30.0）7（12）12（20）1.2 治疗方法60例全部进行了胃癌根治术，其中20例胃空肠吻合，5例进行胃十二指肠吻合，35例胃空肠吻合并周围淋巴结清扫。
40例进行规合理化疗，有10例行了2个疗程化疗。
2 结果2.1 病理结果60例患者中，膜内癌无淋巴结转移15例，黏膜下癌无淋巴结转移10例，黏膜下癌伴淋巴结转移35例。
病理分型，25例为低分化腺癌，20例为中分化腺癌，15例为高分化腺癌。
2.2 随访结果5年生存率80%，3年生存率10%，3年以下生存率为10%。
3 讨论EGC 5年生存率可达95%，而晚期胃癌则为40%左右，但在我国早期胃癌的检出率却很低，一般只有5%~10%，远远落后于韩日的40%~80%。
由于EGC症状无特异性，常无症状或表现为慢性胃炎的症状，加之，胃癌恶性程度高，所以，三早方针就显得非常重要，而胃镜检查重中之重了。
早期胃癌的诊断和外科治疗（附40例报告）
早期胃癌的诊断和外科治疗（附40例报告）
罗勇
【期刊名称】《现代保健：医学创新研究》
【年(卷),期】2007(000)11X
【摘要】目的探讨早期胃癌的临床特点，指导临床诊治和提高疗效。
方法对本院40例早期胃癌在诊断及治疗上的不同特点进行分析。
其中24例有慢性胃病史2～30a，37例临床表现以上腹痛为主，2例表现为上消化道出血、进食哽噎。
胃镜检查40例，上消化道造影检查20例。
胃粘膜层（m）癌22例，粘膜下层（sm）癌18例，淋巴结转移5例。
本组均行D1或D2，其中远端胃大部切除28例，近端胃切除10例，全胃切除2例。
结果全组无手术死亡。
38例获得随访，随访率为95％。
1年、3年、5年生存率分别为100％、95％和87．5％。
结论及时发现和诊断早期胃癌是决定治疗方案和改善预后的主要因素。
并对诊断、治疗和临床对策作了探讨。
【总页数】3页(P63-65)
【作者】罗勇
【作者单位】射阳县人民医院,江苏射阳224300
【正文语种】中文
【中图分类】R735.2
【相关文献】
1.早期胃癌的诊断和外科治疗(附40例报告) [J], 罗勇
2.早期胃癌的外科治疗（附53例报告） [J], 刘训钰;陈怀仁
3.早期胃癌的诊断和外科治疗(附40例报道) [J], 罗勇;刘筠陶;汤国华
4.早期胃癌纤维胃镜诊断的有关问题探讨(附1例罕见的早期胃癌—“一点癌”报告) [J], 江锡珍
5.早期胃癌的诊断及外科治疗体会（附82例临床分析） [J], 胥幼群;徐治康;徐维基;季政一;周立生
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根治性全胃切除治疗胃癌40床分析
根治性全胃切除治疗胃癌40床分析摘要】目的：对根治性全胃切除手术和术后的并发症的治疗经验进行分析和总结[1]。
方法：对这40例患者的资料和治疗过程进行回顾性的分析[2]。
结果：所选的这40例患者在进行根治性全胃切除手术后的五年和十年中，其生存率分别达到了38.11%和18.32%。
术后患者没有引发并发症，同时也无一例手术死亡。
结论：合理、科学的掌握根治性全胃切除手术、选择适合的重建方式、对淋巴结清扫进行规范等是减少并发症和提高愈后的关键因素。
【关键词】根治性全胃切除治疗胃癌临床分析胃癌是我国主要的恶性肿瘤之一，其死亡率也是在各类肿瘤疾病中居于首位。
在治疗方法上仍然是以手术切除为主[3]，与此同时，也选择合理、科学的手术方案。
本文通过对我院曾接收过的40例胃癌患者的切除手术进行分析，并做出如下报告。
1 资料与方法1.1基本资料在这40例患者中，有22例为男性，18例为女性，年龄在23岁到56岁之间。
临床症状大都表现为恶心、呕吐食欲下降、乏力、上腹不适、疼痛，以及进食后饱胀。
肿瘤的部位主要是在胃体贲门部、胃体窦部和胃体底部。
1.2病理资料40例患者全部实行的全麻，其中有32例为经腹手术，其余8例为胸腹联合切口手术。
手术中，发现有8例为全胃癌、20例为胃体癌、7例为胃底贲门癌，仅有5例为胃窦侵及胃体癌，分别占总患者人数的20%、50%、17.5和12.5%。
1.3方法本组选出的40例胃癌患者全部进行了根治性的胃切除手术，联合脏器切除为7例，其中有3例为脾切除，剩余的为胆囊切除。
在消化道的重建方式上，有23例为食管空肠端侧吻合加空肠间 Braum吻合，食管空肠Roux-en-Y吻合的有17例。
2 结果本次选取的40例患者，随访率也达到了80%以上，在术后没有死亡和并发症。
在术后的五年和十年中的生存率分别为38.11%和18.32%。
具体如下表所示：表1 胃癌患者在五年和十年中生存率的统计表3 讨论近些年来，随着监护、麻醉、围手术期的处理和手术技巧的提高[4]，以及临床经验的不断积累，使根治性胃切除手术的死亡率也降低到了5%以下，使胃癌手术治疗的全胃切除率增高，同时也成为了胃癌治疗的主要手段和方法。
胃部分切除手术(PPG)对早期胃癌的临床疗效观察
患治疗 ， 而观察组采取 胃部分切除手术 治疗 ， 观察两组的 治
疗效果 。结果 ： 观察组的 患者术后 １ ５ Ｈ ｌ ｉ ｎ 、 ３ ０ ａ ｒ ｉ ｎ和 ４ ５ ａ ｒ ｉ ｎ以及 ６ ０ ｍ ｉ ｎ时的 胃排 空功能 明显 的优 于对照组的情 况， 而且术后 ４ ５ ａ ｒ ｉ ｎ和 ６ ０ ｍ ｉ ｎ时的胆 裳收缩功能明显的优 于对 照组的情况（ Ｐ＜ ０ ． ０ ５ ） 。两组的 患者术后 生存 率和复发 率的比较无明显的差异（ Ｐ＞０ ． ｏ ５ ） 。结论 ： 临床上 采取 胃部分切 除手术治 疗早 期 胃癌 患者具有较 好 的效 果， 有效的改善 患者 的生活质 量， 值得 临床 中应 用。
况， （ Ｐ＜ ０ ． ｏ ５ ） 。而两组在术后 １ ５ ａ ｒ ｉ ｎ 、 ３ ０ ａｉ ｒ ｎ的胆囊收缩 功能
分析 ， 汁壁资料 采取均数 ± 标准 差 （ ±ｓ ） 表示 ， 并采 取 ｔ 检 验， 计数资 料采取 检验 ， Ｐ＜ ０ ． ０ ５ ， 差 异具有 著性 ， 有统
计学意义 。
二、 结 果
２ ． 诊 断标准 。本组 的患 者均符 合 中华 人 民共 和 国卫 生
部制定《 胃癌诊断标准） （ ２ ０ １ ０ 版） ， 病理分 期均参 照美 国癌症 联合委员会制定 的国际 分期标准 Ｊ 。 ３ ． 治疗 方法 。（ １ ） 观察组手术 方法 。本组 的患 者均采 取 Ｐ Ｐ Ｇ治疗 ， 患者进行 全麻 ， 并选取上 腹正 中作为 手术 切 口， 在 患 者肿瘤上缘 的 ５ ｃ ｍ处商 到距 幽门 ３ ｃ ｍ的位置 进行 部分 胃
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
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
于素悦;陆爱国
【期刊名称】《外科理论与实践》
【年(卷),期】2024(29)1
【摘要】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。
【总页数】6页(P81-86)
【作者】于素悦;陆爱国
【作者单位】上海交通大学医学院附属瑞金医院普外科
【正文语种】中文
【中图分类】R735.2
【相关文献】
1.保留幽门的胃切除术治疗早期胃癌10例分析
2.保留迷走神经-幽门的胃癌根治术在早期胃癌治疗中的应用
3.快速康复外科对早期胃癌腹腔镜辅助保留幽门胃切除术患者营养状态的影响分析
4.腹腔镜下保留幽门胃切除术与远端胃切除术治疗早期胃癌的疗效观察
5.早期胃癌行保留幽门胃切除术的争议与共识
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内镜黏膜下剥离术治疗早期胃癌及癌前病变的临床效果
世界最新 医学信 息文摘 ２０１８年 第 ｌ８卷第 １０期
５１
‰ 床跚 究
内镜 黏 下剥离术 治疗 早期 癌及癌前病 变的临床效果
淤０
摘 要 ： 目 的 对 内镜黏膜 下 剥离术在早 期 胃癌 以及 癌前病 变 中的应用．效果进行评 价。方 法 研究参 与对象为 我院 ２０１６年 ５月份至 ２０ｌ ７年 ５月份 收治的 ８０例 早期 胃癌 以及癌前 病变患者。采 用随机数字表法分 成两组各 ４０例。对 照组予 以常规 开放手术治疗 ；实验
埘 照组 患 者 实 施 常 规 开 放手 术 治疗 ，患 者 仰 卧 ，伞 麻 下 实施 手术 ，于腹 部 正 ，ｔＩ线做 一 ｝ＪＪ口 ，将 腹腔 内组 织逐 层分 离 ， 将 胄 部 充 分 显 露 ，并 对 胃 部 牛Ｈ火 动 静 脉 ｌ０ｌ管 予 以 结 扎 ，切 除 胃忡 瘤 ，并 清 扫 胃 周 罔淋 巴 结 ：
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文 章 编号 ：６４— １６ ２０ ） ２— ０ ４— ３ １７ ４ ３ （ ０ ９ ０ ０ ９ ０
Ｒｅ ｏ ｔｏ Ｐ ｔ ｅ ｔ ｎ ｆ ｕ ｒ ｎ ａ ａ ｅ ｅ ｐ ｔ ｎ ｓｗｉ ａ ｌ ａ ｔｉ ａ ｃ ｒ ｔ ｒ ｕ ｈ ４ ａ ｅ ￣ ｌ － ｐ ｒ ｆＰ Ｇ ｒ ａ ｍｅ ｔ ｒ ｅ ｔＪ ｐ ｎ ｓ ａ ｅ ｔ ｔ ｅ ｒｙ ｇ ｓ ｒｃｃ ｎ ｅ ｈ ｏ ｇ ０ ｐ ｔ ｎ ｃｉ ｏ ｃ ｉ ｈ ｉ ｎ
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９ ・ பைடு நூலகம்
中 国肿 瘤 外 科 杂 志 ２ ０ ０ ９年 ４月 第 １卷第 ２期
Ｃ ｉ ＪＳ ｒ ｎｏ Ａ ｒ２０ Ｖ １１Ｎ ． ｈｎ ｕｇＯ ｃ ， ｐ．０ ９， ｏ． ， ｏ２
论
著
Ｐ Ｇ手 术 治 疗 ４ Ｐ ０例 早 期 胃癌 的诊 治 分 析
陈 志 红
作者单位 ： １０ ２ 江苏 镇江 ， ２２０ 江苏大学附属人民医院 普通外科 作者介绍 ： 陈志红（ ９５一） 男， １６ ， 江苏镇江人 ， 医学博士
Ｚ ｅｊ ｎ １０ ２ Ｃ ｉ ） ｈｎａ ｇ２ ２０ ， ｈｎ ｉ ａ Ａ ｓ ａｔ Ｏｂｅｔ ｅ Ｔ ｖｌａｅｔｅｔｅａｅｔ ｆｃｃ ｆ ｙｏｕ—ｒｓｒｉ ａｔ ｃ ｍ （ Ｐ ｂｔ ｃ ： ｒ ｊｃｉ ｏｅａ ｔ ｈ ｒ ｕ ｃｅ ａｙｏ ｌｒｓ ｅｅｖ ｇｇｓ ｅｔ ｙ Ｐ Ｇ）ｉ ｖ ｕ ｈ ｐ ｉ ｉ ｐ ｐ ｎ ｒ ｏ ｎ ｔｅ ｒａ ｅｔ ｆ ａｌ ｇｓ ｉｃｎｅ Ｅ Ｃ） Ｍｅｈ ｄ Ｒ ｖｅ ｅ ｌ ｉ ｌ ａ ｏｓｃｔ ｅｐｔ ｎｓ ｉ ｈ ｅｔ ｎ ｏ ｒ ａｔｃ ａｃｒ（ Ｇ ． ｔｏ ｓ ｅｉ ｔ ｉ ｃ ｔ ｏ４ ｃｎｅｕｉ ａ ｅｔｗｔ ｔ ｍ ｅ ｙ ｒ ｗ ｈ ｃｎ ａｄ ａ ｆ０ ｖ ｉ ｈ
幽 门 功能 。
在术后住院期间 以及短期随访 中，Ｐ Ｐ Ｇ术后患者 的餐后症状少 ， 胃潴 留
中间段早期 胃癌患者应用 Ｐ Ｇ手术 ， Ｐ 既能达到理想 的根 治效 果 ， 又能满意地保存 了
【 关键词 】 早期 胃癌 ； 幽门保护 胃切 除术 ； 术后评 价 ； 餐后症状 ； 胃潴 留
ｉ ｉ ａａ Ｃ Ｅ ｈ—ｏｇ （ ｅｅ ｌ ｕ ｅ ＂ ｅａｔｅｔｆＰｏｌ＂Ｈ ｓｉ ｌ ｆ ｌ ｔ ｉｎｓ ｎｖｒｔ， ｃ ｔ Ｈ Ｎ Ｚ ｉ ｎ ． Ｇ ｎｒ ｒ ｒ Ｄ ｐ ｒ ｎ ｏ ｅ ｅ ｏ ｔ ｆ ｉ ｅ ｔ ＪａｇｕＵ ｉ ｓｙ ａｄ ｈ ａＳ ｇ ｙ ｍ ｐ ｓ ｐａ Ａ ａ ｄ Ｏ ｉ ｅｉ
ｔｌａ ｄ ｓ ｏｔｔｒ ｆ ｌ ｗ— ｐ ｒ ｓ ａ ｃ ａ ｎ ｈ ｒ— ｍ ｏｌ ｕ ｅ ｅ ｒｈ，ｂ ｔ ｏ ｔ ｒ ｎ ｉｌｓ ｍｐ ｏ ｎ ａ ｔ ｃ ｓａ ｉ ｓ ｍｐ ｏ ｅ ｅ ｌｓ ． Ｃｏ － ｅ ｏ ｏｈ ｐ ｓｐ ａ ｄ ａ ｙ ｔ ｍｓ ａ ｄ ｇ ｓｒ ｔ ｓ ｙ ｔｍｓｗ ｒ ｅ ｓ ｉ ｓ ｎ ｃｕ ｉｎ Ｔ ｉ ｓ ｄ ｎ ｉ ａｅ Ｐ ｒ ｃ ｄ ｒ ａ ｏ ｄ ｔｃ ｎ ｑ ｅ ｉ ｒ ａ ｍｅ ｔｏ ＧＣ ａ ｈ ｄ ｌ ｏ ｔ ｎ ｌ ｓｏ ｈ ｓ ｔ ｙ ｉ ｄ ｃ ｔ ｄ Ｐ Ｇ ｐ ｏ ｅ ｕ ｅ ｗ ｓ ａ ｇ ｏ ｅ ｈ ｉ ｕ ｎ ｔ ｔ ｎ ｆＥ ｔｔ ｅ ｍｉ ｄ ｅ ｐ ｒｉ ｕ ｅ ｏ ｆ ｒｉ ｅｆ ｃ ｒ ｄ ｃ ｌ ｙ ｅ ｆｃ ｓ ｗ ｌ ａ ｔ ｓ ｔ ｆ ｃｏｙ ｆ ｎ ｔ ｎ ｌ ｒ ｓ ｒ ａｉｎ ｏ ｙ ｏ ｕ ． ０ ｔ ｐ ｒｅ ｔ ａ ｉａ ｉ ｆ ｔ ｅ ｌ ｓ ｉ ａｉ ａ ｔｒ ｕ ｃｉ ａ ｅ ｅｖ ｔ ｆｐ ｌ ｒ ｓ ｓ ｔ ｅ ａ ｓ ｓ ｏ ｐ ｏ Ｋｅ ｒ ｓ Ｅ ｒ ａ ｔ ｃ ｃ ｎ ｅ ； ｙ ｗｏ ｄ ： ａ ｌ ｇ ｓｒ ａ ｃ ｒ ｙ ｉ ｐ ａ ｄ ａ ｙ ｔｍｓ Ｇ ｓｒ ｔｎ ｉｎ ｒ ｎ ｉｌＳ ｍｐｏ ； ａ ｔｉ Ｒｅｅ ｔ ｃ ｏ Ｐ ｌ ｒ ｓ ｐ ｅ ｅ ｖｎ ａ ｔ ｃｏ ； ｙ ｏ ｕ — ｒ ｓ ｒ ｉ ｇ ｇ ｓ ｅ ｔｍｙ ｒ Ｐ ｓｏ ｅａ ｉｅ ｅ ａｕ ｔ ｎ； ｏ ｔｐ ｒ ｔ ｖ ｌ ａｉ ｖ ｏ Ｐ ｓ ｏｔ —
ｔ ｅ ｐ ｅ ｐ ｒ ｔ ｅｄ ａ ｎ ｓｓｏ ＧＣ ｗ ｏｒ ｃ ｉｅ Ｐ ｔｅ ｔ ｎ ａ ａ ｅ ｅ Ｎａｉ ｎ ｌ ａ ｃ ｒＣ ｎ ｅ ｓ ｉ ｌ ｕ — ｈ ｒ ｏ ｅ ａｉ ｉｇ ｏ ｉ ｆＥ ｈ ｅ ｅｖ ｄ Ｐ Ｇ ａｍｅ ｔｉ Ｊ ｐ ｎ ｓ ｔ ａ ｎ ｅ ｅ ｔ ｒＨｏ ｐ ｔ ｒ ｖ ｒ ｎ ｏ Ｃ ａｄ ｉ ｇ ｔ ｅ ｐ ｒ ｄ ｆｏ Ｓ ｐ ． １ ２ ０ ｏ Ｊ ｎ １ ２ ０ ．Ｒｅ ｕｌ Ｄ ｒ ｇ ｔ ｅ ｐ ｒ ｄ ｏ ｏ ｔ ｐ ｒ ｔ ｅ ｓａ ｎ ｈ ｓ ｉ ｎ ｈ ｅ ｏ ｒｍ ｅ ｔ ， ０ ７ ｔ ａ ． ０， ０ ８ ｉ ｓ ｔ ｓ ｕ ｉ ｈ ｅ ｉ ｆｐ ｓｏ ｅ ａｉ ｔｙ ｉ ｏ ｐ — ｎ ｏ ｖ
【 摘要 】 目的 探讨幽 门保护 胃切 除术 （ｙ ｒ — ｅ ｒｎ ｓｅｔ ｙ Ｐ Ｇ 在早期 胃 ｐｌｕ ｐ ｓ ｖ ｇ ａｒ ｏ ， Ｐ ） ｏ ｓ ｒ ｅ ｉ ｇ ｔｃ ｍ 癌患者 中的
应用效果 。方法 回顾性分 析 了 日本 国立癌 中心病 院从 ２０ ０ ７年 ９月 １日到 ２ ０ ０ ８年 １ １ ｔ 间 ４ 月 ０ Ｅ之 ０ 例 Ｐ Ｇ手术 的临床资料 。结果 Ｐ 症状也不 多。结论