Abstract: Controversy and consensus on pylorus-preserving gastrectomy for early gastric cancer        ZHAO En-hao, ZHU Chun-chao, ZHAO Gang. Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
Corresponding author: ZHAO Gang, E-mail:zhaogang74313@
aliyun.com
Abstract    Pylorus-preserving gastrectomy is one of the modified gastrectomies for early gastric cancer in the middle part of the stomach, and it is also an important function in preserving gastrectomy. It preserves the normal anatomical and physiological functions of the stomach on the premise of ensuring oncological safety. It also improves the long-term quality of life and nutritional status of patients. With the continuous improvement of the detection rate of early gastric cancer, this procedure has been popularized and promoted in Japan and South Korea. In recent years, it has also been gradually carried out in China. Its surgical indications, preoperative preparation, the procedure of operation, and other details have been standardized, but there are still many controversies and focal issues. Totally laparoscopy is more minimally invasive than laparoscopic-assisted surgeries, but it has higher requirements for intraoperative localization of lesions. Lymph node dissection in the infrapyloric area tends to be more accurate, but preoperative staging is particularly important. The most important complication of pylorus-preserving gastrectomy is delaying gastric emptying. Reducing the incidence of local edema through supplying a sufficient amount of blood and ensuring appropriate drainage in the pylorus during operation has become a hot topic in current research.

Key words: early gastric cancer, pylorus-preserving gastrectomy, laparoscope, complication

摘要： 保留幽门胃切除术是胃中部早期胃癌的缩小手术方式之一，也是重要的保留功能胃切除术，在确保肿瘤学安全性的前提下保留了胃的正常解剖和生理功能，对于病人长期生活质量和营养状况有较好的改善。该术式伴随着早期胃癌检出率的不断提高在日韩得以普及和推广，近年来在国内也逐步开展，其手术适应证、术前准备、手术操作步骤等细节也不断规范，但仍然存在诸多争议和焦点问题。完全腹腔镜较腹腔镜辅助更具微创优势，但对于术中病灶定位有较高的要求；幽门下区的淋巴结清扫趋于更精准，但术前分期尤为重要；而保留幽门胃切除术最主要的并发症则是胃排空障碍，通过术中保护幽门部静脉减少局部水肿，进而降低其发生率成为目前研究的热点。

关键词: 早期胃癌, 保留幽门胃切除术, 腹腔镜, 并发症