进展期胃癌术式选择及术中腹腔化疗探析  

Surgical Procedure Selection and Intraoperative Intra-abdominal Chemotherapy for Patients with Advanced Gastric Cancer

作　　者：张高嘉[1] 郭建生[1] 王仆[1] 郝希山[1] 

机构地区：[1]天津市肿瘤防治重点实验室天津医科大学附属肿瘤医院综合外科,天津市300060

出　　处：《中国肿瘤临床》2008年第22期1317-1320,共4页Chinese Journal of Clinical Oncology

摘　　要：阐述晚期胃癌TNMⅣ期,其复发形式多见于腹膜播散性转移和种植,并影响预后之重要因素。即使进行根治术,亦仅称之为非治疗性切除术。进展期胃癌进行广泛淋巴清扫价值始终存在分歧和争议。侵出浆膜之患者其五年治疗率低下。肉眼腹膜种植者,腹腔游离癌细胞近乎100%。伴随侵出面积增大,其治疗率而降低。肿瘤标志物监测诸如TPA,CA724,CA242,CA199以及CEA等,睿智据理规范和启迪术式及术中化疗之实施,选定多元化特异性高的标志物检测,可提高敏感性,皆阳性者则诊断无疑。临床残留癌细胞是客观存在,术中第一时间强烈干预腹腔内置入抗癌药物为最理想。诸如MMC-CH,CDDP,Vp16以及区域性缓释化疗抗肿瘤植入剂Sinofuan等不乏为首选。晚期胃癌循规蹈矩进行D2或D3术式,难以达到期望阈值。D2术式不能提高患者生存率。D1,D2术式术后生存率统计学上分析无明显差异。淋巴清扫仅有助于病理分期确切性,偏倚扩大根治术,善其予后难以期待。Peritoneal dissemination is commonly found in stage 4 gastric cancer patients and it is a key factor in the prognosis of advanced gastric cancer. Radical resection for gastric cancer is still controversial and is considered a palliative procedure. In patients with tumors penetrating through the serosa, the 5-year survival rate is low. Isolated cancer cells almost always exist when peritoneal metastasis is detectable by the naked eye. Patients with more tumor invasion out of the stomach have a lower survival rate. Combined use of biomarkers TPA, CA242, CA212, CA199, and CEA can increase the sensitivity of diagnosis. When residual tumor is clinically confirmed, intraoperative peritoneal chemotherapy should be administered. Anti-cancer agents such as MMC-CH, CDDP, VP-16 and controlled-release Sinofuan can be used. For patients with advanced gastric cancer, it is hard to predict the outcome of traditional D2 or D3 radical resection. D2 resection does not increase patient survival. No statistical significance was found in survival rates between D1 and D2 resection. Lymph node resection is only helpful for the identification of precise pathological staging. Expanded radical resection does not improve the survival of patients with advanced gastric cancer.

关 键 词：晚期胃癌 肿瘤标志物 术中腹腔化疗 

分 类 号：R735.2[医药卫生—肿瘤] R657.4[医药卫生—临床医学]