The Clinical Study And Observation Of Vagus Nerve-Preserving Radical Gastrectomy For Gastric Cancer

Background and purpose:Gastric cancer is one of the most common malignant tumors which are threatening the health of human being in the world. There have been great improvements in the elementary,empodistic and clinical study for gastric cancer in recent years, and the complex therapy pattern has been formed, in which surgery is the fundamental and chemotherapy, radiotherapy, biology immunotherapy are the adjunctive therapy. The radical surgery is the cornerstone for gastric cancer's therapy and it is the only way that can cure gastric cancer. After more than one century's development ,the surgical technic for gastric cancer has maken remarkable progress, and the clinical datas indicate that the gastric cancer patients'five-year survival rate has been raised. Raising the patients'quality of life has become the hot spot in the surgical therapy for gastric cancer in many clinical organizations . According to the 13th edition Japanese therapic specification for gastric cancer ,it is easy to damage the vagus nerve near the stomach. when performing radical surgery and lymphadenectomy. The damage of the vagus nerve can influence the patients'quality of life, so some experts advocate the vagus never-preserving radical gastrectomy for gastric cancer. Because it is so difficult to preserve vagus nerve that the requirement for the clinician is quite high in all aspect of quality. By now it is only developed in some clinical organizations (mainly in Japan), and the clinical reports are mainly about the early gastric cancer. While in China, the diagnosis rate for gastric cancer is quite low,90% patients of gastric cancer have been in the late period when diagnosed. This experiment studies the preserving vagus radical gastrectomy to cure gastric cancer, which has been carried out on the progressive period of gastric cancer in our hospital,by observing the recent curative effect of the patients, and evaluating the necessity, the feasibility, the security as well as the influence on patients'life quality. The purpose is to provide clinical material for the improvement of the radical resection for gastric cancer.Clinical material and method:30 patients with progressive period were collected to accept preserving vagus radical gastrectomy for gastric cancer in Surgical Department in our hospital ,Since November 2006 to September 2007. And 30 patients with progressive period were collected to accept the traditional classic radical resection for gastric cancer,as a comparision. All the selected cases accepted preoperative endoscopy and were confirmed gastric cancer by pathology. All cases successfully finished radical resection more than D2. The main purpose was to observe whether there were differences between the two groups in the operation time, blood loss, the lymph node cleaning scope, lymph node cleaning quantity, the number of postoperative complications after operation in hospital, the recovery of gastrointestinal function after operation (first exhaust time , first defecation time, whether there was adverse symptoms after eating); To find whether there were differences in the two groups in the gallbladder disease, cholelithiasis, diarrhea, discomfort after eating and the changes in the residual stomach under gastroscopy by visiting the patients in the two groups after 6-8 months surgery.Result:The average surgery time of the preserving vagus radical gastrectomy group was 216.00±13.48min, which was longer than that of opening abdomen group (207.33±12.23min) (P <0.05); the surgery time of preserving vagus radical gastrectomy of former 15 cases (221.67±15.08min) was longer than latter 15 cases (210.33+8.96min). The surgery time of latter 15 cases compared with traditional surgery group ,there was no significant difference (P>0.05);The preserving vagus radical gastrectomy group campared with traditional surgery group, there was no significant difference in the average amount of hemorrhage (P>0.05).The patients in both the preserving vagus radical gastrectomy group and the traditional surgery group accepted the surgery According to the 13th edition Japanese therapic specification for gastric cancer (D2, D3). The average number of total cleaning lymph node,N1 station cleaning lymph node, N2 and the above station cleaning lymph node were 32.23±1.59, 16.30±0.99, 15.93±1.08 in preserving vagus radical gastrectomy group, 33.00±1.44, 16.67±0.88, 16.33±0.92in the traditional surgery group. There was no significant difference in the number of total cleaning lymph node,N1 station cleaning lymph node, N2 and the above station cleaning lymph node. The preserving vagus radical gastrectomy group compared with traditional surgery group, there was no significant difference (P>0.05)in postoperative complications after operation in hospital, the recovery of gastrointestinal function after operation :first exhaust time , first defecation time, inability incidence of stomach. There was significant difference in adverse symptoms after eating(P<0.05). There was significant difference (P<0.05)in the incidence rates of the gallbladder disease, cholelithiasis, diarrhea, discomfort after eating between the two groups; there was no significant difference ( P>0.05 ) in weight recovery, Local environmental of remnant stomach (bile reflux, gastric atrophy).Conclusion: 1 It is available and safe to perform the preserving vagus radical gastrectomy for gastric cancer, which can achieve the same level of cleaning the lymph node compared with the traditional surgery.2 The patients who acceptted the preserving vagus radical gastrectomy for gastric cancer have lower incidence rates of the gallbladder disease, cholelithiasis, diarrhea, discomfort after eating than those in traditional surgery.