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Gastric Cance:保留迷走神经肝分支可减少胃切除术后胆结石形成的风险

2020-08-07 MedSci原创 MedSci原创

随着内镜筛查的普及和胃癌综合治疗模式的推广,这几十年来胃癌的预后已经得到了极大的改善,因此,医生们开始更加注重改善患者功能预后和生活质量。

    随着内镜筛查的普及和胃癌综合治疗模式的推广,这几十年来胃癌的预后已经得到了极大的改善,因此,医生们开始更加注重改善患者功能预后和生活质量。

    胆石症被称为胃切除术的长期并发症之一,胃切除术后胆囊结石(GBS)的发生率普遍在10%左右,而我国的发生率略低,约7%左右。

    有研究表明,与匹配的正常人群相比,胃切除术后的患者可能出现症状性胆结石的风险更高,而其中的缘由目前还不清楚,胃切除术后GBS形成率增加的病理生理机制尚未完全了解,GBS形成的潜在原因可能包括迷走神经肝分支损伤,非生理重建以及术后粘连引起的胆道畸形等原因,因此引起了科学家们的研究兴趣。

    最近韩国的一家研究机构对首尔国立大学医院的进行保留幽门的胃切除术(LPPG)和腹腔镜远端(LDG)的患者进行了回顾性研究,对神经保留(h-DG,h-PPG)组和牺牲(s-DG,s-PPG)组胆结石的发生率进行比较,从而探究保留迷走神经肝分支对预防胆结石的作用。

图:手术方式

    研究结果显示:h-DG组的3年累积胆石发生率(2.7%,n= 85),明显低于s-DG组(14.6%, n= 238)(p= 0.017),而h-PPG组的结石发生率为(1.6 %,  n= 123),比s-PPG组也低(12.9%,  n= 21)(p=0.004)。h-DG和s-DG之间的总体术后并发症发生率相似(p  = 0.861),h-PPG和s-PPG 之间的总体术后并发症发生率相似(p= 0.768)。迷走神经损伤(p= 0.001)和高体重指数(BMI)(≥27.5 kg/m2)(p = 0.040)是胆结石形成的独立危险因素。

    因此,文章最后说道对于早期胃癌患者的LDG和LPPG手术方式,建议保留迷走神经肝分支,以减少术后胆结石的形成。

 

原始出处:

Chao-Jie Wang. Et al. Preservation of hepatic branch of the vagus nerve reduces the risk of gallstone formation after gastrectomy. Gastric Cancer.2020.

 

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    2020-08-29 许安
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    2020-11-30 skhzy
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    2020-08-09 bshuang

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