Pilot Study Of Hepatici Branch Of Vagus Nerve’s Function-Preserving Radical Gastrectomy

Background and purpose:Gastric cancer is one of the major malignant tumors that harmful to human health.since1881doctor Billroth finished the first gastrectomy There have been great improvements in the elementay、empodistic and clinical study for gastric cancer, and the gastric cancer patients’ five-year survival rate has been raised。but after more than one century’s development,The radical surgery is still the cornerstone for gastric cancer’s therapy,and Raising the patients’ quality of life has become the hot spot in the surgical therapy for gastric cancer in many clinical organizations. According to the3th edition Japanese gastric cancer treatment Guidelines, Vagus nerve-preserving radical gastrectomy has gradually become the standard surgical treatment for early gastric cancer.but for advanced gastric cancer, vagus nerve-preserving radical gastrectomy still lacks the support from randomized clinical trials on large sample。in China,90%patients of gastric cancer have been in the late period when diagnosed. 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。This experiment studies the hepatici branch of Vagus Nerve-Preserving radical gastrectomy by observing the recent curative effect of the patients diagnosed of progressive period gastric cancer. The purpose is to evaluate the necessity, the feasibility, the security as well as the availability of the new radical gastrectomy, and to provide clinical material for the improvement of the radical resection for gastric cancer.Clinical material and method:Since March2010to September2011,15patients with progressive period were collected to accept hepatici branch of Vagus Nerve-Preserving radical gastrectomy for gastric cancer in Surgical Department of our hospital, another15patients with progressive period were collected to accept the traditional classic radical resection for gastric cancer,as a comparision. All the selected cases accepted preoperative endoscopic ultrasound (EUS) and were confirmed gastric cancer by pathology. All the cases successfully finished radical resection as D2. The main purpose was to observe whether there were differences between the two groups in the blood loss, operation time, the lymph node cleaning scope, lymph node cleaning quantity, the number of complications in or after the operationl, the recovery of gastrointestinal function after operation. To find whether there were differences in the two groups in the gallbladder disease, cholelithiasis, diarrhea,liver function and blood glucose level by visiting the patients in the two groups after6months surgery.Result:The average surgery time of the hepatici branch of Vagus Nerve-Preserving radical gastrectomy group was216.20±15.48min, which was longer than that of traditional surgery group (204.23±12.54min)(P<0.05); the surgery time of hepatici branch of Vagus Nerve-Preserving radical gastrectomy of former10cases (224.45±16.01min) was longer than latter5cases (209.31±11.06min). The surgery time of latter5cases compared with traditional surgery group,there was no significant difference (P>0.05);The hepatici branch of Vagus Nerve-Preserving 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 hepatici branch of Vagus Nerve-Preserving radical gastrectomy group and the traditional surgery group accepted the surgery According to the3th edition Japanese gastric cancer treatment Guidelines for gastric cancer (D2). The average number of total cleaning lymph node, N1station cleaning lymph node, N2station cleaning lymph node were31.17±1.87,16.07±0.09、15.10±1.18in hepatici branch of Vagus Nerve-Preserving radical gastrectomy group,32.01±1.54、16.21±0.91、15.80±1.04in the traditional surgery group. There was no significant difference in the number of total cleaning lymph node,Nl station cleaning lymph node, N2station cleaning lymph node. The hepatici branch of Vagus Nerve-Preserving radical gastrectomy group compared with traditional surgery group, there was no significant difference (P>0.05) in postoperative complications, the recovery of gastrointestinal function after operation:first exhaust time, first defecation time. There was significant difference (P<0.05) in the incidence rates of the gallbladder disease,cholelithiasis between the two groups; there was no significant difference (P>0.05) in the postoperative blood glucose level.Conclusion:1It is safe and available to perform the hepatici branch of Vagus Nerve-Preserving radical gastrectomy for gastric cancer, which can achieve the same level of cleaning the lymph node compared with the traditional radical gastrectomy.2The patients who acceptted the hepatici branch of Vagus Nerve-Preserving radical gastrectomy for gastric cancer have lower incidence rates of the gallbladder disease,cholelithiasis than those in traditional radical gastrectomy.3. compared to the traditional radical gastrectomy, the hepatici branch of Vagus Nerve-Preserving radical gastrectomy may have positive influence on the recovery of postoperative Gastrointestinal function, but the effection on liver function and blood glucose level have not been confirmed.