摘要
迷走神经的精准解剖是功能保留性胃切除术的关键要素。在技术层面,术中神经监测联合吲哚菁绿荧光导航、手术入路优化、机器人手术系统以及人工智能辅助手术规划导航系统等技术革新,极大地提升了迷走神经保护的精准性和可行性。然而,仍存在一些争议:肝支保护已成共识,但腹腔支保护因操作难度和对淋巴结清扫彻底性的潜在影响仍需更多高质量证据支持;对于新辅助治疗后显著降期的病人,能否安全实施保留神经的缩小手术甚至免除手术,以及进展期胃癌的神经保护的肿瘤学安全性,是未来研究的重要方向。精准保护迷走神经是改善胃癌病人术后生活质量的关键,需结合技术进步和循证医学证据持续推进个体化精准手术发展。
The precise dissection of the vagus nerve has become a critical element in the technical chain of function-preserving gastrectomy(FPG).At the technical level,innovations such as intraoperative nerve monitoring combined with navigation by indocyanine green fluorescence,optimization of surgical approaches,robotic surgical systems,and artificial intelligence(AI)-assisted surgical planning and navigation systems have significantly enhanced the precision and feasibility of vagus nerve preservation.However,controversies persist:while preservation of the hepatic branch has become a consensus,preservation of the celiac branch still requires more high-quality evidences due to its technical difficulty and potential impact on the thoroughness of lymph node dissection.Future research directions include:determining the safety of implementing nerve-preserving,reduced surgery or even exempt from surgery in patients achieving significant downstaging after neoadjuvant therapy,as well as evaluating the oncological safety of nerve preservation in advanced gastric cancer.In conclusion,precise vagus nerve preservation is crucial for improving the postoperative quality of life of gastric cancer patients.Advancing personalized and precision surgery requires the continued integration of technological progress combined with evidence-based medicine.
作者
张子臻
曹晖
ZHANG Zi-zhen;CAO Hui(Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200120,China)
出处
《中国实用外科杂志》
北大核心
2025年第7期759-762,共4页
Chinese Journal of Practical Surgery
基金
国家自然科学基金项目(No.82103510,No.82303428,No.82473077,No.82473065)
癌症系统医学国家重点实验室项目(No.KF2205-93)
上海市教育委员会“人工智能促进科研范式赋能学科跃升计划”项目(No.JWAIZD-6)
上海市卫生健康委员会医学新技术研究与转化种子计划项目(No.2024ZZ2020)。
关键词
胃癌
功能保留性胃切除术
迷走神经
精细解剖学
gastric cancer
function preserving gastrectomy
vagus nerve
meticulous anatomy
