减瘤手术对胃癌腹腔内种植转移患者生存时间的影响  

Impact of cytoreductive surgery on survival in gastric cancer patients with peritoneal metastasis

作　　者：刘书尚 刘克[1] 刘震[1] 柰超[1] 肖书傲 郭曼[1] 连肖[1] 杨学文[1] 柳金强 张洪伟[1] 

机构地区：[1]第四军医大学西京医院消化一科,西安710032

出　　处：《中华胃肠外科杂志》2016年第1期37-40,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（31100643）

摘　　要：目的探讨减瘤手术对发生腹腔内种植转移的胃癌患者生存时间的影响。方法回顾性分析2008年5月至2015年4月间第四军医大学西京消化病医院消化一科收治的术前评估未发现转移、而术中探查发现腹腔弥散粟粒样种植转移的151例胃腺癌患者的临床资料。其中32例患者予以肿瘤局部根治性切除加区域淋巴结清扫的减瘤手术，术后追加以氟尿嘧啶为基础方案的辅助化疗（减瘤联合化疗组）；39例患者单纯接受减瘤手术（单纯减瘤组）；23例患者行探查联合以氟尿嘧啶为基础方案的术后辅助化疗（探查联合化疗组）；57例患者仅单纯行探查手术（单纯探查组）。比较4组患者的总生存时间。结果全组151例患者中，148例（98．0％）获得随访，中位随访时间为7．2（1．4～61．2）月，减瘤联合化疗组中位生存时间为11．9（95％CI：8．8～15．1）月，单纯减瘤组为7．1（95％CI：3．2—11．1）月，探查联合化疗组为8．2（95％CI：4．6～11．8）月，单纯探查组为5．4（95％a：4．4—6．4）月，4组间的差异有统计学意义（P〈0．01）。结论对于腹腔内种植转移的晚期胃癌患者，减瘤手术可延长生存时间，联合术后辅助化疗的治疗效果更佳。Objective To investigate the survival benefit of cytoreductive surgery in gastric cancer patients with peritoneal metastasis. Methods Clinicopathological data of 151 advanced gastric adenocarcinoma patients with extensive peritoneal metastasis who were identified by surgical exploration between May 2008 and April 2015 in Xijing Hospital of Digestive Diseases were analyzed retrospectively. Of all the patients, 32 cases were treated by cytoreductive surgery with local radical tumor resection and regional lymph node cleaning, combined with fluorouracil-based adjuvant chemotherapy after surgery （cytoreductive surgery combined with chemotherapy group）; 39 caseswere only treated by cytoreductive surgery group （cytoreductive surgery group）;23 caseswere treated bysurgical exploration combined with fluorouracil-based adjuvant chemotherapy after surgery （surgical exploration combined with chemotherapy group） and 57 cases were only treated bysurgical exploration （surgical exploration group）. The overall survival of four groups were analyzed and compared. Results Among the 151 patients, 148 （98.0%） patients were followed up. The median follow up time was 7.2 months （range 1.4-61.2）. The median survival of cytoreductive surgery combined with chemotherapy group, cytoreductive surgery group, surgical exploration combined with chemotherapy group and surgical exploration group was 11.9 （95% CI： 8.8-15.1） months, 7.1 （95% CI： 3.2-11.1） months, 8.2 （95% CI：4.6-11.8） and 5.4 （95% CI：4.4-6.4） months, respectively （P 〈 0.01）. Conclusions Cytoreductive surgery can prolong the survival of gastric adenocarcinoma patients with extensive peritoneal metastasis. Cytoreductive surgery combined with chemotherapy may provide more benefit for patients, and can be used as a choice of treatment in these patients.

关 键 词：胃肿瘤 腹膜转移 减瘤手术 化疗 生存时间 

分 类 号：R735.2[医药卫生—肿瘤]