胃癌转化治疗后腹腔镜的应用及体会(附7例报告)  

Application and experience of laparoscopy for gastric cancer after transformation therapy(report of 7 cases)

作　　者：曹铭富 杨永江[1] 苏卓彬[1] 黄迪[1] 李曙光[1] 赵轶峰[1] Cao Mingfu;Yang Yongjiang;Su Zhuobin;Huang Di;Li Shuguang;Zhao Yifeng(Department of Gastrointestinal Tumor Surgery,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院胃肠肿瘤外科,张家口075000

出　　处：《中国医师杂志》2022年第3期334-337,共4页Journal of Chinese Physician

基　　金：河北省政府资助临床医学优秀人才培养和基础课题研究项目(361009)。

摘　　要：目的探讨Ⅳ期胃癌转化治疗后腹腔镜的应用价值。方法回顾性分析2016年1月至2020年12月河北北方学院附属第一医院收治的7例经转化治疗后行腹腔镜手术的晚期胃癌的临床资料。7例患者经CT、PET-CT、腹腔镜等诊断为Ⅳ期胃癌,行以紫杉醇为基础的转化治疗,评估疗效后行手术切除。分析患者术中、术后情况和生存率等指标。结果转化治疗后,部分缓解6例,疾病稳定1例,总体有效率6/7。腹腔镜辅助手术3例,中转开腹4例。手术时间(297.9±35.6)min,术中出血量(257.0±106.0)ml,清扫淋巴结数(38.4±9.1)枚,胃管留置时间(72.4±9.6)h,空肠营养管留置时间(15.4±5.6)d,恢复流质饮食时间(8.6±3.4)d,住院时间(17.1±5.5)d。术后并发症发生率为3/7,无非计划二次手术及死亡病例。R0切除6例,R1切除1例。肿瘤退缩分级:2级5例,3级2例。7例患者中位无进展生存期为15.3个月,中位总生存期为21.6个月,1年生存率为6/7。结论腹腔镜对转化治疗胃癌的分期和疗效判定具有不可替代的价值,但转化治疗后组织水肿加重,肿瘤边界更加不清,手术操作难度增大,故不必强求腹腔镜操作,可视情况中转开腹。Objective To investigate the application value of laparoscopy for stageⅣgastric cancer after transformation therapy.Methods The clinical data of 7 patients with advanced gastric cancer who underwent laparoscopic surgery after transformation therapy in the First Affiliated Hospital of Hebei North University from January 2016 to December 2020 were retrospectively analyzed.Seven patients were diagnosed as stageⅣgastric cancer by computed tomography(CT),positron emission tomography(PET-CT)and laparoscopy,and underwent paclitaxel based conversion therapy.After evaluating the curative effect,they underwent surgical resection.The intraoperative and postoperative conditions and survival rate of the patients were analyzed.Results After transformation therapy,6 patients(85.7%)had partial remission,1 patient(14.3%)had stable disease,and the overall effective rate was 6/7.Laparoscopic-assisted surgery was performed in 3 patients,and 4 patients were converted to laparotomy.The operation time was(297.9±35.6)min,the intraoperative blood loss was(257.0±106.0)ml,the number of dissected lymph nodes was(38.4±9.1),the gastric tube indwelling time was(72.4±9.6)h,the jejunal feeding tube indwelling time was(15.4±5.6)d,and the liquid diet time was(8.6±3.4)d,the length of hospital stay was(17.1±5.5)d.The postoperative complication rate was 3/7,and there were no unplanned secondary operations and deaths.R0 resection was performed in 6 cases,and R1 resection in 1 case.Tumor regression grade(TRG)classification:5 cases were grade 2 and 2 cases were grade 3.The median progression free survival of the 7 patients was 15.3 months,the median overall survival was 21.6 months,and the 1-year survival rate was 6/7.Conclusions Laparoscopy has irreplaceable value in the staging and efficacy judgment of transformation therapy for gastric cancer.However,after transformation therapy,the tissue edema increases,the tumor boundary becomes more unclear,and the surgical operation becomes more difficult.Therefore,it is not necessary to force the lap

关 键 词：胃肿瘤 转化治疗 腹腔镜检查 

分 类 号：R735.2[医药卫生—肿瘤]