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ENGLISH ABSTRACT
胃癌保功能手术的发展现状和前景展望
邢继尧
苗儒林
陕飞
李子禹
作者及单位信息
·
DOI： 10.3760/cma.j.cn441530-20250103-00006
Development status and prospects of functional preservation surgery for gastric cancer
Xing Jiyao
Miao Rulin
Shan Fei
Li Ziyu
Authors Info & Affiliations
Xing Jiyao
Gastrointestinal Tumor Center, Peking University Cancer Hospital & Institute, Beijing Institute for Cancer Research, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
Miao Rulin
Gastrointestinal Tumor Center, Peking University Cancer Hospital & Institute, Beijing Institute for Cancer Research, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
Shan Fei
Gastrointestinal Tumor Center, Peking University Cancer Hospital & Institute, Beijing Institute for Cancer Research, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
Li Ziyu
Gastrointestinal Tumor Center, Peking University Cancer Hospital & Institute, Beijing Institute for Cancer Research, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
·
DOI： 10.3760/cma.j.cn441530-20250103-00006
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摘要

胃癌保功能手术是一种以改善术后功能为核心目标的治疗策略，在确保肿瘤学安全性的前提下，通过保留贲门、幽门和迷走神经等重要解剖结构以及消化、分泌、排空和抗反流等关键功能，最大限度地减少对患者术后生活质量的负面影响。随着新辅助治疗模式的广泛应用和抗肿瘤药物疗效的不断提高，保功能手术的应用前景和适应证范围也有望进一步拓展。本文从胃癌保功能手术的主要类型、新辅助治疗后的应用以及新技术探索等方面阐述其发展现状和未来前景。

胃肿瘤;保功能手术;新辅助治疗
ABSTRACT

Function-preserving surgery for gastric cancer is a treatment strategy aimed at improving postoperative function while ensuring oncological safety. By preserving important anatomical structures such as the cardia, pylorus, and vagus nerve, as well as key functions like digestion, secretion, emptying, and anti-reflux, this approach aims to minimize the negative impact on patients' postoperative quality of life. With the widespread application of neoadjuvant treatment and the continuous improvement in the efficacy of anti-tumor drugs, the application and indications for functional-preserving surgery may further expand. This article reviews the current status and future prospects of function-preserving surgery for gastric cancer, focusing on its main types, applications after neoadjuvant therapy, and the exploration of new technologies.

Stomach neoplasms;Functional preservation surgery;Neoadjuvant therapy
Li Ziyu, Email: mocdef.kabooltuoyrogergil
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邢继尧,苗儒林,陕飞,等. 胃癌保功能手术的发展现状和前景展望[J]. 中华胃肠外科杂志,2025,28(02)：127-133.

DOI:10.3760/cma.j.cn441530-20250103-00006

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胃癌保功能手术是一种以改善术后功能为核心目标的治疗策略，在确保肿瘤学安全性的前提下，通过保留贲门、幽门和迷走神经等重要解剖结构以及消化、分泌、胃排空和抗反流等关键功能，最大限度地减少对患者生活质量的负面影响。根据《中国胃癌保功能手术外科专家共识（2021版）》，保功能手术主要适用于早期胃癌患者，其核心是在缩小手术范围、合理选择消化道重建方式的基础上，兼顾肿瘤根治性与患者生活质量 ［ 1 ］ 。
早期胃癌淋巴结转移风险较低，患者预后良好，5年生存率可达90%以上，是保功能手术的主要适应证 ［ 2 ］ 。随着胃镜筛查的普及，我国早期胃癌的诊断率逐年提高。2017年中国胃肠肿瘤外科联盟数据显示，我国外科治疗患者中早期胃癌的比例为19.5% ［ 3 ］ 。但目前我国胃癌患者仍以局部进展期为主，对保功能手术的广泛应用构成了挑战。近年来，新辅助治疗模式的普及为局部进展期胃癌的外科治疗策略带来了新的思考。新辅助化疗有助于降低肿瘤分期，部分患者甚至可达到病理完全缓解（pathological complete response，pCR） ［ 4 ］ 。随着免疫检查点抑制剂等在临床中的应用，进一步助力了抗肿瘤疗效 ［ 5 ］ 。加之放疗、靶向药物等的研究进展，为保功能手术适应证人群的拓展提供了可能性。新辅助治疗后获得降期的局部进展期胃癌患者，不失为保功能手术潜在的选择人群。本文将从胃癌保功能手术的主要类型、新辅助治疗后的应用以及新技术探索等方面，阐述其发展现状和未来前景，以期为临床实践提供新的启示。
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备注信息
A
李子禹，Email： mocdef.kabooltuoyrogergil
B
邢继尧, 苗儒林, 陕飞, 等. 胃癌保功能手术的发展现状和前景展望[J]. 中华胃肠外科杂志, 2025, 28(2): 127-133. DOI: 10.3760/cma.j.cn441530-20250103-00006.
C
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