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中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 228 -231. doi: 10.3877/cma.j.issn.1674-3946.2021.02.030

所属专题: 文献

综述

保留幽门胃切除术后胃排空功能障碍的原因及防治
周家杰1, 汪刘华2, 李东亮3, 王道荣2,()   
  1. 1. 116044 大连医科大学
    2. 225001 扬州大学临床医学院,江苏省苏北人民医院,扬州大学-扬州市普通外科研究所,南京医科大学扬州临床医学院,大连医科大学扬州临床医学院
    3. 225002 扬州大学医学院
  • 收稿日期:2020-04-20 出版日期:2021-04-26
  • 通信作者: 王道荣

The etiology prevention and treatment of gastric emptying dysfunction Causes and prevention of gastric emptying dysfunction after pyloric preserving gastrectomy

Jiajie Zhou1, Liuhua Wang2, Dongliang Li3, Daorong Wang2,()   

  1. 1. Dalian Medical University
    2. Department of General Surgery, The northern Jiangsu people's Hospital
    3. Yangzhou University
  • Received:2020-04-20 Published:2021-04-26
  • Corresponding author: Daorong Wang
  • Supported by:
    The fifth high-level talent fostering project in Jiangsu province(333 Project, BRA2017153)
引用本文:

周家杰, 汪刘华, 李东亮, 王道荣. 保留幽门胃切除术后胃排空功能障碍的原因及防治[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(02): 228-231.

Jiajie Zhou, Liuhua Wang, Dongliang Li, Daorong Wang. The etiology prevention and treatment of gastric emptying dysfunction Causes and prevention of gastric emptying dysfunction after pyloric preserving gastrectomy[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(02): 228-231.

保留幽门胃切除术(PPG)治疗早期胃癌(EGC)通过减少胃切除的范围、保留幽门、保留迷走神经能够显著改善患者术后生活质量,降低术后倾倒综合征、胆汁返流及胆石症的发生率。腹腔镜辅助保留幽门胃切除术(LAPPG)将微创理念及功能保留结合,具有低侵袭性,最低限度的小肠麻痹,术后早期康复等优势。然而,无论PPG或LAPPG,术后早期胃排空功能障碍(GEF)的发生率较高,表现为食物长期存留于残胃之中,病人通常有饱腹感。本文综述近几年行PPG术后胃排空功能障碍的相关研究进展,为临床一线外科医生行PPG或LAPPG治疗EGC时防治GEF提供参考建议。

Pylorus-preserving gastrectomy(PPG) for early gastric cancer(EGC) can significantly improve postoperative quality of life and reduce the incidence of postoperative dumping syndrome, bile reflux and cholelithiasis by reducing the scope of gastrectomy, pyloric spare-gastrectomy and vagus nerve spare-gastrectomy. Laparoscopic assisted Pylorus-preserving gastrectomy (LAPPG) combines minimally invasive concepts and functional retention with low invasiveness, minimal intestinal paralysis, and early postoperative gastric empty dysfunction (GEF), which is characterized by prolonged retention of food in the residual stomach and a general feeling of satiety in patients. This article reviews the study of gastric emptying dysfunction after PPG in recent years, and provides recommendations for clinical first-line surgeons to treat gastric emptying dysfunction after PPG or LAPPG treatment of early gastric cancer.

图1 胃幽门下区解剖图示[A:为示意图;IPV:幽门下静脉、RGEV:胃网膜右静脉、ASPDV:胰十二指肠上前静脉、ARCV:副结肠右静脉、Cut line:结扎点、Duodenum:十二指肠、Avascular:无血管区域。B:为实景图,红圈为无血管区域]
图2 完全腹腔镜技术辅助下PPG手术胃窦与近端残胃的端端吻合"刺穿法"图示[A:"刺穿法"示意图;B:"刺穿法"实景图]
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