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双镜联合前哨淋巴结导航手术对早期胃癌术后胃排空功能及生活质量影响：一项前瞻性随机对照试验
王子萌, 侯祎, 郑智, 王巍, 徐瑞, 赵宇, 张海翘, 刘小野, 刘揆亮, 蔡军, 孙秀静, 朱圣韬, 杨吉刚, 陈光勇, 尹杰, 张军, 李鹏, 张忠涛, 张澍田
中国实用外科杂志 ›› 2026, Vol. 46 ›› Issue (5) : 660-668.
PDF(2294 KB)
PDF(2294 KB)
双镜联合前哨淋巴结导航手术对早期胃癌术后胃排空功能及生活质量影响：一项前瞻性随机对照试验
Evaluation of the efficacy of laparoscopic-endoscopic cooperative surgery combined with sentinel lymph node navigation surgery on postoperative gastric emptying and quality of life in patients with early gastric cancer: A prospective randomized controlled trial
目的 探讨腹腔镜、内镜双镜联合前哨淋巴结导航手术（LECS-SNNS）对早期胃癌（EGC）病人胃排空功能及生活质量（QoL）的影响。方法 采用前瞻性随机对照试验研究方法。连续纳入2023年8月至2025年8月首都医科大学附属北京友谊医院诊治的100例EGC病人，1∶1随机分配至LECS-SNNS组（50例）与腹腔镜标准胃癌根治术（LSG）组（50例）。比较两组病人的基线资料、围手术期指标、术后胃排空功能、营养状况及QoL。采用核素显像法测定胃半排空时间（GET1/2）。结果 LECS-SNNS组有4例因术中证实淋巴结转移转行LSG，最终LECS-SNNS组46例纳入分析。两组病人基线资料比较差异无统计学意义（P>0.05）。与LSG组相比，LECS-SNNS组手术时间更短（165.1 min vs. 206.2 min）、术中出血量更少（21.5 mL vs. 52.3 mL），术后首次肛门排气时间、首次流质饮食时间及术后住院时间均更短，差异有统计学意义（P<0.05）。胃排空功能方面，术后3个月LECS-SNNS组GET1/2与术前水平差异无统计学意义（67.0 min vs. 57.0 min，P>0.05），LSG组GET1/2较术前显著延长，差异有统计学意义（129.0 min vs. 56.5 min，P<0.05）。营养评估结果显示，术后3个月两组白蛋白及血红蛋白水平均恢复良好，但LECS-SNNS组预后营养指数显著高于LSG组（P<0.05）。QoL评分方面，LECS-SNNS组在术后3个月的总体健康状况、功能领域评分及身心健康总分均优于LSG组，在反流症状、进食限制、单餐进食量及症状总分等方面也表现更佳，差异有统计学意义（P<0.05），且LECS-SNNS组反流、口干、体像障碍等症状评分与术前相比差异无统计学意义（P>0.05）。随访期间，所有病人均未见肿瘤复发或远处转移。结论 对于经过严格筛选的EGC病人，LECS-SNNS在确保近期肿瘤根治效果的同时，兼具功能保留与微创优势，能够改善术后胃功能恢复和短期QoL。相较于LSG，LECS-SNNS为EGC的个体化治疗提供了一种兼具根治与保功能优势的选择。
Objective To evaluate the impact of laparoscopic-endoscopic cooperative surgery combined with sentinel lymph node navigation surgery (LECS-SNNS) on gastric emptying function and quality of life (QoL) in patients with early gastric cancer (EGC). Methods A prospective randomized controlled trial (RCT) design was adopted. A total of 100 patients with EGC who were diagnosed and treated at Beijing Friendship Hospital Affiliated to Capital Medical University between August 2023 and August 2025 were consecutively enrolled, and randomly assigned at a 1∶1 ratio to the LECS-SNNS group (n=50) and the laparoscopic standard gastrectomy (LSG) group (n=50). We evaluated baseline demographics, perioperative parameters, nutritional status, QoL, and gastric emptying function. Specifically, gastric emptying half-time (GET1/2) was assessed via radionuclide scintigraphy. Results In the LECS-SNNS group, 4 cases were confirmed to have lymph node metastasis during the operation and were converted to LSG. Ultimately, 46 cases in the LECS-SNNS group were analyzed.There were no statistically significant differences in baseline characteristics between the two groups (P>0.05). LECS-SNNS showed shorter operative time (165.1 min vs. 206.2 min), reduced blood loss (21.5 mL vs. 52.3 mL), and faster recovery (flatus, diet, and discharge) compared to LSG, with statistically significant differences (all P<0.05). Regarding gastric emptying function, at 3 months postoperatively, there was no statistically significant difference in the GET1/2 between the LECS-SNNS group and its preoperative level (67.0 min vs. 57.0 min, P>0.05). In contrast, the GET1/2 of the LSG group was significantly prolonged compared with its preoperative level, with a statistically significant difference (129.0 min vs. 56.5 min, P<0.05). The nutritional assessment showed that at 3 months postoperatively, the levels of albumin and hemoglobin in both groups recovered well; however, the Prognostic Nutritional Index (PNI) of the LECS-SNNS group was significantly higher than that of the LSG group (P<0.05). At 3 months postoperatively, the LECS-SNNS group showed superior QoL scores compared to the LSG group, with significant improvements in global health status, functional scales, physical/mental component summaries, reflux symptoms, eating restrictions, meal size, and total symptom scores, with statistically significant differences (all P<0.05). No recurrence occurred during follow-up. Conclusion In strictly selected EGC patients, LECS-SNNS achieves short-term oncological safety with the benefits of functional preservation and minimal invasiveness, leading to improved gastric function recovery and short-term QoL. Thus, LECS-SNNS represents a viable alternative to LSG for individualized EGC treatment, optimizing the balance between oncological cure and functional retention.
双镜联合前哨淋巴结导航手术 / 早期胃癌 / 胃排空功能 / 生活质量
laparoscopic-endoscopic cooperative surgery combined sentinel lymph node navigation surgery / early gastric cancer / gastric emptying function / quality of life
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李博文, 肖琼, 宗瑞刚, 等. 人工智能助力胃肠肿瘤诊治的新进展[J]. 中国实用外科杂志, 2026, 46(1):41-45. DOI:10.19538/j.cjps.issn1005-2208.2026.01.09.
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Gastroparesis is a condition characterized by epigastric symptoms and delayed gastric emptying (GE) rate in the absence of any mechanical obstruction. The condition is challenging in clinical practice by the lack of guidance concerning diagnosis and management of gastroparesis.
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郑智, 王子萌, 徐瑞, 等. 内镜-腹腔镜胃区域性切除联合前哨淋巴结引流区清扫术在早期胃癌患者中的应用研究[J]. 中华外科杂志, 2025, 63(7):587-596. DOI: 10.3760/cma.j.cn112139-20250117-00034.
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This study aimed to compare laparoscopic standard gastrectomy (LSG) and laparoscopic sentinel node navigation surgery (LSNNS) for early gastric cancer (EGC) in terms of 5-year long-term oncologic outcomes.
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To compare postoperative complications, long-term survival, and quality of life (QOL) after laparoscopic sentinel node navigation surgery (LSNNS) and laparoscopic standard gastrectomy (LSG).
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The Sentinel Node Oriented Tailored Approach (SENORITA) randomized clinical trial evaluated quality of life (QoL) and nutritional outcomes between the laparoscopic sentinel node navigation surgery (LSNNS) and laparoscopic standard gastrectomy (LSG). However, there has been no report on the QoL and nutritional outcomes of patients who underwent stomach-preserving surgery among the LSNNS group.To compare long-term QoL and nutritional outcomes between patients who underwent stomach-preserving surgery and those who underwent standard gastrectomy and to identify factors associated with poor QoL outcomes in patients who underwent stomach-preserving surgery.This study is a secondary analysis of the SENORITA trial, a randomized clinical trial comparing LSNNS with LSG. Patients from 7 tertiary or general hospitals across the Republic of Korea were enrolled from March 2013 to December 2016, with follow-up through 5 years. Data were analyzed between August and September 2022. Among trial participants, patients who underwent actual laparoscopic standard gastrectomy in the LSG group and those who underwent stomach-preserving surgery in the LSNNS group were included. Patients who did not complete the baseline or any follow-up questionnaire were excluded.Stomach-preserving surgery vs standard gastrectomy.Overall European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORTC QLQ-C30) and stomach module (STO22) scores, body mass index, hemoglobin, protein, and albumin levels.A total of 194 and 257 patients who underwent stomach-preserving surgery and standard gastrectomy, respectively, were included in this study (mean [SD] age, 55.6 [10.6] years; 249 [55.2%] male). The stomach-preserving group had better QoL scores at 3 months postoperatively in terms of physical function (87.2 vs 83.9), dyspnea (5.9 vs 11.2), appetite loss (13.1 vs 19.4), dysphagia (8.0 vs 12.7), eating restriction (10.9 vs 18.2), anxiety (29.0 vs 35.2), taste change (7.4 vs 13.0), and body image (19.5 vs 27.2). At 1 year postoperatively, the stomach-preserving group had significantly higher body mass index (23.9 vs 22.1, calculated as weight in kilograms divided by height in meters squared) and hemoglobin (14.3 vs 13.3 g/dL), albumin (4.3 vs 4.25 g/dL), and protein (7.3 vs 7.1 g/dL) levels compared to the standard group. Multivariable analyses showed that tumor location (greater curvature, lower third) was favorably associated with global health status (β, 10.5; 95% CI, 3.2 to 17.8), reflux (β, -8.4; 95% CI, -14.7 to -2.1), and eating restriction (β, -5.7; 95% CI, -10.3 to -1.0) at 3 months postoperatively in the stomach-preserving group. Segmental resection was associated with risk of diarrhea (β, 40.6; 95% CI, 3.1 to 78.1) and eating restriction (β, 15.1; 95% CI, 1.1 to 29.1) at 3 years postoperatively.Stomach-preserving surgery after sentinel node evaluation was associated with better long-term QoL and nutritional outcomes than standard gastrectomy. These findings may help facilitate decision-making regarding treatment for patients with early-stage gastric cancer.ClinicalTrials.gov Identifier: NCT01804998.
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Japanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition)[J]. Gastric Cancer, 2022, 26(1):1-25. DOI: 10.1007/s10120-022-01331-8.
The sixth edition of the Japanese Gastric Cancer Treatment Guidelines was completed in July 2021, incorporating new evidence that emerged after publication of the previous edition. It consists of a text-based "Treatments" part and a "Clinical Questions" part including recommendations and explanations for clinical questions. The treatments parts include a comprehensive description regarding surgery, endoscopic resection and chemotherapy for gastric cancer. The clinical question part is based on the literature search and evaluation by an independent systematic review team. Consequently, not only evidence for each therapeutic recommendation was clearly shown, but it also identified the research fields that require further evaluation to provide appropriate recommendations.© 2022. The Author(s).
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中华医学会外科学分会腹腔镜与内镜外科学组, 中国研究型医院学会机器人与腹腔镜外科专业委员会, 中国抗癌协会腔镜与机器人外科分会, 等. 腹腔镜胃癌手术操作指南(2023版)[J]. 中国实用外科杂志, 2023, 43(4):361-370. DOI: 10.19538/j.cjps.issn1005-2208.2023.04.01.
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中国医师学会外科医师分会上消化道学组, 中华医学会外科学分会胃肠外科学组, 中国医师协会外科医师分会肿瘤外科学组. 中国胃癌保功能手术外科专家共识(2025版)[J]. 中华胃肠外科杂志, 2025, 28(2):109-120. DOI: 10.3760/cma.j.cn441530-20250106-00011.
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The goal of the present retrospective study was to elucidate the efficacy of conserving the celiac branch (CB), which can reduce the adverse reactions of Billroth-Ⅰ (B-Ⅰ) restoration after the laparoscopy-assisted distal gastrectomy (LADG).Two hundred thirty-three patients with gastric cancer underwent B-Ⅰ reconstruction after LADG with dissection 2 lymphadenectomy from July 2005 to July 2012 and were monitored for 5 y. The patients were separated into 2 groups: celiac branch preserved (P-CB) group (n = 98) and celiac branch resected (R-CB) group (n = 135). In addition to patient information, tumor features, and surgical details, short-term and long-term variables such as bowel condition, surgical complications, and endoscopy findings were evaluated.In short-term efficacy, the time of first flatus and liquid ingestion were slightly shorter in the P-CB group than in the R-CB group (3.84 ± 0.74 versus 4.38 ± 0.71, P = 0.0001; 5.04 ± 1.07 versus 5.67 ± 1.10, P = 0.0001). For long-term efficacy, the incidences of chronic diarrhea, gastroparesis, residual food, bile reflux, and reflux esophagitis were less in the P-CB group compare with the R-CB group (6.1% versus 22.2%, P = 0.001; 5.1% versus 17.8%, P = 0.004; 4.1% versus 17.8%, P = 0.004; 8.2% versus 17.8%, P = 0.036; 8.2% versus 17.8%, P = 0.036). Other parameters such as postoperative ileus and gallstones had a better efficacy trend in the P-CB group but did not suggestively vary among the groups.The CB has an imperative part in the gastrointestinal motility, and celiac preservation mainly exerts long-term efficacy in patients who underwent B-I surgery with LADG.Copyright © 2019 Elsevier Inc. All rights reserved.
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Radical gastric cancer surgery can cause functional and physiological disorders due to the resection of perigastric vagus nerves. Few studies have used intraoperative neurophysiological monitoring and indocyanine green (ICG) labeling to preserve the perigastric vagus nerve and to evaluate the corresponding effects.
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To evaluate the long-term outcomes of laparoscopic pylorus-preserving gastrectomy (LPPG) with laparoscopic distal gastrectomy (LDG) for early gastric cancer.
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利益冲突 所有作者均声明不存在利益冲突
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