Ⅲ期胃癌的临床病理特点及外科治疗分析  

Clinical Pathology and Treatment of Gastric Carcinoma in Ⅲ Stage

作　　者：秦环龙[1] 林超鸿[1] 

机构地区：[1]上海市第六人民医院普外科,上海市200233

出　　处：《中国肿瘤临床》2002年第11期781-784,共4页Chinese Journal of Clinical Oncology

基　　金：上海市科委科技发展重点项目基金资助

摘　　要：目的:探讨Ⅲ期胃癌的临床病理特点与外科治疗的效果。方法:采用不同治疗方法,其中D2淋巴结廓清组114例,D3淋巴结廓清组102例,术中放疗(IORT)组48例,腹腔化疗加肿瘤浸润淋巴细胞(TIL)腹腔灌注治疗组18例,并分析治疗效果。结果:本组总淋巴结转移率79.5%(384/484),转移度为41.2%(4169/10121);第1站、第2站、第3站和第4站淋巴结转移阳性率分别为68.8%、34.6%、19.6%和3.5%;浆膜与周围组织或器官粘连23.2%,其中癌性粘连12.5%。D3淋巴结廓清组1、3、5、8、10年生存率明显高于D2淋巴结廓清组,IORT组5年生存率明显增加;术中43℃(温热)蒸馏水+术后腹腔化疗+肿瘤浸润淋巴细胞(TIL)灌注治疗明显减少腹膜种植转移率。结论:Ⅲ期胃癌患者因其临床病理的特殊性,手术力求切除足够的胃和淋巴结,结合IORT及各种措施的腹腔灌注治疗,来提高Ⅲ期胃癌患者的长期生存率。Objective:To study the Clinical pathology and the treatment of gastric carcinoma inⅢstage.Methods:484cases of gastric carcinoma inⅢstage were treated from1975～1997,and their clinicopathology feature were analysised,the different treatment methods were compared,including D 2 ?D 3 lymphadenectomy ,IORT and peritoneal infusing chemotherapy combi nation with TIL,and their effects were evaluated.Results:The total of lymph node metastasis(LNM)was79.5%(384/484),and the degree of LNM41.2%(4169/10121),The rates of LNM of N 1 ?N 2 ?N 3 and N 4 were68.8%?34.6%?19.6%and3.5%,respectively.The rate of serosa linking to peripheral tissue or organ was23.15%(112/484),the rate of cancerous link was12.5%(13/112).The sur vival rate of D3lymphadenectomy in1?3?5?8and10years were higher than that of D 2 lym phadenectomy,P<0.05～0.01.The5year survival rate in IORT was longer than in only group op eration,P<0.05～0.01.Peritoneal lavage with2000ml of43℃distilled water before closure of ab dominal wound and postoperation peritoneal infusing chemotherapy combining TIL decreased significantly the rate of peritoneal metastasis.Conclusion:Due to specificity of the gastric carcinoma inⅢstage,the surgical principle forⅢstage remains the extensive radical operation,in combi nation with IORT and different peritoneal infusing therapy to improve the5year survival rate.

关 键 词：胃癌 外科治疗 病理学 临床分析 

分 类 号：R735.2[医药卫生—肿瘤] R730.[医药卫生—临床医学]