Abstract: Laparoscopic assisted pylorus preserving gastrectomy with preservation of the first branch of the right gastroepiploic vein in early gastric cancer：A clinical analysis of 54 patients        ZHUANG Chun*，ZHANG Zi-zhen，ZHU Chun-chao，et al.  *Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
Corresponding author：ZHAO Gang,E-mail：zhaogang74313@aliyun.com
ZHUANG Chun and ZHANG Zi-zhen are the first authors who contributed equally to the article.
Abstract    Objective    To explore the safety and feasibility of modified laparoscopic assisted pylorus-preserving gastrectomy（LAPPG），which preserves the first branch of the right gastroepiploic vein（RGEV）. Methods    The preoperative，intraoperative，postoperative and follow-up results of 54 cases of early gastric cancer（T1）in the middle part of the gastric body treated with first branch of RGEV preserved LAPPG（F-LAPPG）in Renji Hospital，Shanghai Jiaotong University School of Medicine from October 2016 to June 2019 were analyzed retrospectively. Results    All patients received F-LAPPG successfully，without laparotomy conversions or switched to C-LAPPG surgery. The mean operation time of the F-LAPPG procedure was（175.6±20.2）min；the estimated intraoperative blood loss was（54.1±29.1） mL；the mean number of lymph node dissections was（28.3±6.5）；the first postoperative flatus time was（3.2±1.6）days；the postoperative gastric tube indwelling time was（3.2±1.4）days. The mediate length of postoperative hospital stay was（7.1±1.5）days. One case（1.9%）of gastric emptying disorder occurred postoperatively，but with no grade Ⅱ or severer complications. Radionuclide imaging during the postoperative follow-up showed that the gastric emptying time was（99.6±16.2）min，and the mean residual rate in stomach after 120min was（39.5±9.9）%. Conclusion F-LAPPG is safe and feasible in the treatment of early gastric cancer in the middle of the stomach. It can also more accurately protect the venous reflux of pyloric sleeve and the gastric stump function therefore improve the gastric emptying time and the residual rate in the stomach after meal.

Key words: early gastric cancer, laparoscopic assisted pylorus preserving gastrectomy, preserving the first branch of right gastroepiploic vein, gastric emptying disorder

摘要： 目的    探讨保留胃网膜右静脉（RGEV）第一分支的改良腹腔镜辅助保留幽门胃切除术（LAPPG）在早期胃癌治疗中的安全性和可行性。方法    回顾性分析自2016年10月至2019年6月间上海交通大学医学院附属仁济医院胃肠外科收治并行保留RGEV第一分支LAPPG（F-LAPPG）治疗的54例胃体中部早期胃癌（T1）病人术前、术中、术后及随访结果。结果    54例病人均成功实施 F-LAPPG，无中转开放及改行经典LAPPG（C-LAPPG）手术。手术时间（175.6±20.2）min，术中失血（54.1±29.1）mL，淋巴结清扫数目（28.3±6.5）枚，术后排气时间（3.2±1.6）d，术后胃管留置时间（3.2±1.4）d，术后住院天数（7.1±1.5）d，术后发生胃排空障碍1例（2.2%），无Ⅱ级以上并发症，术后随访中核素显像胃半排空时间（99.6±16.2）min，餐后120 min胃内残留率（39.5±9.9）%。 结论    F-LAPPG治疗早期胃体中部癌安全可行，其对术后幽门袖静脉回流以及在残胃功能的保护更为确切，从而能改善胃半排空时间及餐后胃内残留率。

关键词: 早期胃癌, 腹腔镜辅助保留幽门胃切除术, 保留胃网膜右静脉第一分支, 胃排空障碍