定型的幽門側胃切除術と比較した幽門保存胃切除術の予後およびＱＯＬの評価

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  • Evaluation of Pylorus Preserving Gastrectomy Compared with Conventional Distal Gastrectomy

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Introduction: Distal gastrectomy (DG) is a standard procedure for early gastric cancer located in lower and middle third of the stomach. Although pylorus preserving gastrectomy (PPG), one of the function preserving gastrectomies which has recently been applied for early gastric cancer, evaluation of this procedure has not yet been finalized. Patients and method: In this study, 71patients who underwent PPG were evaluated by prognosis, postoperative complications, abdominal symptoms examined by questionnaire survey and endoscopic findings of the residual stomach. Patients who underwent DG were examined by same items and the results were compared with those of the PPG group. Results: There was no significant difference in the survival rates of the two groups. The incidence of gastric stasis in the early postoperative period was higher in the PPG group (14.1%) compared with the DG group (3.4%). From the results of the questionnaire, the incidence of symptoms of regurgitation was lower in the PPG group (13.4%) than the DG group (38.0%). Early dumping syndrome such as abdominal sound, abdominal pain and diarrhea occured less frequently in the PPG group (36.2%) than the DG group (60.5%). Sixty-nine percent of PPG group patient had food residue in the remnant stomach as assessed endoscopically, which was higher than the DG group (32.5%). Gastritis and bile reflux in the gastric remnant were observed in 33.3% and 5.1% of the PPG group, and 68.3% and 22.0% of the DG group, respectively. Conclusion: PPG has advantages of lower incidences of the dumping syndrome, bile reflux and gastritis in the remnant stomach compared with DG. On the other hand, PPG has disadvantage in gastric empting over DG, but according to the results of the questionnaire, there was no difference in symptoms concerning residual food. PPG thus, seems to be the better procedure than DG from the point of view of the patient's QOL.

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