腹腔镜胃癌根治术中保留迷走神经肝支对术后胃排空障碍及胆汁反流的影响

Effects of preserving the hepatic branch of the vagus nerve during laparoscopic radical gastrectomy for gastric cancer on postoperative delayed gastric emptying and bile reflux

摘要:

目的 探讨腹腔镜远端胃癌根治术中保留迷走神经肝支对术后胃排空障碍、胆汁反流、胆囊功能及营养状态的影响。方法 回顾性分析2021年3月—2025年3月宣城市人民医院收治并行腹腔镜远端胃癌根治术的112例胃癌患者的临床资料，根据术中是否保留迷走神经肝支分为观察组和对照组，各56例。观察组术中在保证肿瘤根治性及淋巴结清扫质量的前提下保留迷走神经肝支，对照组行常规腹腔镜远端胃癌根治术，术中不刻意保留迷走神经肝支。比较两组围手术期恢复及胃排空障碍、术后胆汁反流及残胃黏膜情况、胆囊相关结局、营养状态、安全性及肿瘤根治性指标。结果 观察组首次排气时间、首次排便时间及术后住院时间均短于对照组，胃排空障碍发生率低于对照组（P <0.05）。术后6、12个月，观察组胆汁反流发生率、残胃食物残留R≥2级发生率、残胃炎G≥2级发生率均低于对照组（P <0.05）。术后6、12个月，观察组胆囊收缩率高于对照组，胆泥/胆囊结石形成率低于对照组（P <0.05）。术后12个月，观察组白蛋白、预后营养指数均高于对照组（P <0.05）；观察组术前至术后12个月白蛋白差值高于对照组，预后营养指数下降幅度小于对照组（P <0.05）。两组术后吻合口漏、吻合口出血、腹腔感染、肠梗阻发生率及淋巴结清扫总数、阳性淋巴结数、R₀切除率比较，差异均无统计学意义（P >0.05）。结论 腹腔镜远端胃癌根治术中保留迷走神经肝支可在保证肿瘤根治性的前提下，有效促进术后胃肠功能恢复，降低胃排空障碍、胆汁反流及胆泥/胆囊结石发生风险，改善患者术后营养状态，且不增加围手术期并发症及肿瘤复发风险，值得临床推广。

Abstract:

Objective To evaluate the effects of preserving the hepatic branch of the vagus nerve during laparoscopic radical distal gastrectomy on postoperative delayed gastric emptying, bile reflux, gallbladder function, and nutritional status.Methods The clinical data of 112 patients with gastric cancer who underwent laparoscopic radical distal gastrectomy at Xuancheng People's Hospital from March 2021 to March 2025 were retrospectively analyzed. The patients were divided into an observation group and a control group according to whether the hepatic branch of the vagus nerve was preserved during surgery, with 56 patients in each group. In the observation group, the hepatic branch of the vagus nerve was preserved while ensuring radical tumor resection and adequate lymph node dissection. The control group underwent conventional laparoscopic radical distal gastrectomy without deliberate preservation of the hepatic branch of the vagus nerve. The two groups were compared in terms of perioperative recovery, delayed gastric emptying, postoperative bile reflux and remnant gastric mucosal status, gallbladder-related outcomes, nutritional status, safety, and oncological radicality.Results The times to first flatus and first defecation and the postoperative hospital stay were shorter in the observation group than in the control group, and the incidence of delayed gastric emptying was lower (P < 0.05). At 6 and 12 months after surgery, the incidences of bile reflux, grade ≥ 2 food retention in the remnant stomach, and grade ≥ 2 remnant gastritis were lower in the observation group than in the control group (P < 0.05). At 6 and 12 months after surgery, the gallbladder contraction rate was higher and the incidence of biliary sludge/gallstone formation was lower in the observation group than in the control group (P < 0.05). At 12 months after surgery, the serum albumin level and Prognostic Nutritional Index (PNI) were higher in the observation group, and the change in albumin from baseline to 12 months postoperatively was greater in the observation group than in the control group, while the magnitude of PNI decline was smaller in the observation group (P < 0.05). There were no significant differences between the two groups in the incidences of anastomotic leakage, anastomotic bleeding, abdominal infection, and intestinal obstruction; the total number of dissected lymph nodes; the number of positive lymph nodes; or the R₀ resection rate (P > 0.05).Conclusion Preservation of the hepatic branch of the vagus nerve during laparoscopic radical distal gastrectomy can promote postoperative gastrointestinal recovery, reduce the risks of delayed gastric emptying, bile reflux, and biliary sludge/gallstone formation, and improve postoperative nutritional status while maintaining oncological radicality. It does not increase perioperative complications or the risk of tumor recurrence.