晚期胃癌转化治疗后手术切除的临床效果分析  

Clinical efficacy of surgical resection after conversion therapy for advanced gastric cancer

作　　者：贾凯[1] 王立维 马俊杰[1] 马晋峰[1] 徐钧 Jia Kai;Wang Liwei;Ma Junjie;Ma Jinfeng;Xu Jun(Department of General Surgery,Shanxi Provincial Cancer Hospital,Taiyuan 030013,China;Department of General Surgery,Shanxi Norman Bethune Hospital,Taiyuan 030032,China)

机构地区：[1]山西省肿瘤医院普外科,太原030013 [2]山西白求恩医院普外科,太原030032

出　　处：《肿瘤研究与临床》2019年第11期756-759,共4页Cancer Research and Clinic

基　　金：山西省重点研发计划(一般)社会发展项目(201703D321010-1)。

摘　　要：目的观察晚期胃癌患者转化治疗后手术切除的临床效果。方法回顾性分析2015年1月至2017年10月山西省肿瘤医院收治的23例晚期胃癌患者的临床资料。患者均接受多学科诊疗(MDT)指导的转化治疗,在非治愈性因素消失后行D2胃癌根治术。分析患者转化治疗后的缓解情况及术中、术后相关指标。结果23例患者经转化治疗后,完全缓解2例(8.7%),部分缓解13例(56.5%),疾病稳定8例(34.8%),转化治疗缓解率为65.2%(15/23)。手术时间(135.5±32.1)min,术中出血量(356.7±101.3)ml,清扫淋巴结(35.5±10.3)枚。胃管留置时间(70.5±29.6)h,恢复流质饮食时间(85.0±21.5)h,引流管放置时间(196.2±36.2)h,术后住院时间(10.7±3.2)d。术后2例发生IDa级并发症,2例发生II级并发症。所有患者均获得随访,中位无进展生存时间为13.5个月,中位总生存时间为21.9个月。结论晚期胃癌患者经过以MDT为指导的转化治疗后行D2胃癌根治术可延长生存期。Objective To observe the clinical effect of surgical resection after conversion therapy for patients with advanced gastric cancer.Methods The clinical data of 23 patients with advanced gastric cancer who were admitted to Shanxi Provincial Cancer Hospital from January 2015 to October 2017 were retrospectively analyzed.All patients underwent multi-disciplinary treatment(MDT)-directed conversion therapy,and D2 radical gastrectomy was performed after the disappearance of non-healing factors.The remission of patients after conversion therapy and the related intraoperative and postoperative indicators were analyzed.Results After the conversion therapy,there were 2 cases(8.7%)of complete remission,13 cases(56.5%)of partial remission and 8 cases(34.8%)of stable disease.The remission rate of the conversion therapy was 65.2%(15/23).In all 23 cases,the surgical time was(135.5±32.1)min,the intraoperative blood loss was(356.7±101.3)ml,the number of lymph nodes resected was 35.5±10.3.The time of gastric tube indwelling was(70.5±29.6)h,the time to first liquid intake was(85.0±21.5)h,the time of drainage tube placement was(196.2±36.2)h and the postoperative hospital stay was(10.7±3.2)d.After surgery,two cases had grade III A post-operative complications and 2 had grade D.All patients were followed up,the median progression-free survival time was 13.5 months and the median overall survival time was 21.9 months.Conclusion The survival time of patients with advanced gastric cancer can be prolonged by D2 radical gastrectomy after the MDT-guided conversion therapy.

关 键 词：胃肿瘤 外科手术 转化治疗 多学科诊疗 

分 类 号：R735.2[医药卫生—肿瘤]