PANCREAS-PRESERVING TOTAL GASTRECTOMY FOR PROXIMAL GASTRIC-CANCER
PANCREAS-PRESERVING TOTAL GASTRECTOMY FOR PROXIMAL GASTRIC-CANCER
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DOI：
10.1007/bf00294714
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发表时间：
1995-07-01
影响因子：
2.6
通讯作者：
OKAJIMA, K
中科院分区：
文献类型：
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作者：
MARUYAMA, K;SASAKO, M;OKAJIMA, K
胰腺上缘淋巴结清扫是胃癌根治性手术的重要环节之一，而胰腺远端常被切除以沿着脾动脉完全清除淋巴结。然而，在接受胰脏切除术的病患中，胰液漏、膈下脓疡及术后糖尿病是常见的并发症。为了避免这些问题，1979年Maruyama开发了一种新的外科手术，即保留胰腺的手术。我们发现来自胃的淋巴管不流入胰腺实质，并且脾、脾动脉和脂肪结缔组织（包括淋巴结）可以在不分离胰腺实质和脾静脉的情况下完全切除。保存的胰腺通过胰横动脉接受动脉血供，其保存可预防术后糖尿病。共有299名患者接受了该手术治疗。手术死亡率为0.3%，住院死亡率为1.6%，手术并发症发生率为19.6%。II期患者的累积5年生存率为70.5%，III期患者为54.1%。这些结果上级优于胰腺切除组。
Lymph node (LN) dissection along the upper border of the pancreas is one of the essential parts of curative surgery for gastric cancer, and the distal portion of the pancreas was frequently resected for complete removal of LNs along the splenic artery. However, pancreatic juice leakage, subphrenic abscess, and postoperative diabetes were common complications in patients treated by pancreatic resection. To avoid these problems a new surgical procedure, the pancreas-preserving operation, was developed by Maruyama in 1979. We found that lymphatic channels from the stomach did not flow into the pancreas parenchyma, and that the spleen, splenic artery, and fatty connective tissue including nodes could be removed completely without dissection of the pancreas parenchyma and splenic vein. The preserved pancreas receives its arterial blood supply through the transverse pancreatic artery, and its preservation prevents postoperative diabetes. A total of 299 patients were treated by this procedure. The operative mortality rate was 0.3%, the hospital death rate 1.6%, and the surgical complications rate 19.6%. The cumulative 5-year survival rate for those with stage II was 70.5% and for those with stage III 54.1%. These results were superior to those of the pancreas resection group.