胃癌腹膜转移伴腹腔积液的治疗策略  

Treatment strategies for gastric cancer with peritoneal metastasis and ascites

作　　者：马君俊[1] 李树春 臧潞[1] MA Jun-jun;LI Shur-chun;ZAGN Lu(Department of General Surgery,Riuijin Hospital,Shanghai Jiao-Tong Universily School of Medicine,Shanghai Minimal Invasire Surgery Center,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院普通外科,上海市微创外科临床医学中心,上海200025

出　　处：《中国实用外科杂志》2024年第10期1120-1125,共6页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金面上项目(No.82372933);中央高校基本科研业务费专项基金资助(No.YG2023ZD03)。

摘　　要：胃癌腹膜转移发病率高且预后差,多数病人中位生存时间<1年。目前,腹膜转移的诊断主要依靠影像学检查,但隐匿性腹膜转移的诊断仍具有挑战性,腹腔镜探查不仅能够直观地观察转移性病灶,同时能够进行组织学和脱落细胞学检测,故应作为胃癌腹膜转移诊断的常规手段。胃癌腹膜转移的治疗是目前研究的热点,由于存在血浆-腹膜屏障,故单纯的全身系统治疗对胃癌腹膜转移的疗效有限。近年来各种腹腔内局部治疗的方式愈发受到重视,其中以新辅助化疗联合腹腔内常温化疗为代表的治疗方式有助于部分伴有中等量腹腔积液的胃癌腹膜转移病人改善症状、转化为可切除状态,最终延长预后。针对不同严重程度的胃癌腹膜转移,选择合理的治疗手段及时机,仍是今后研究的重点。The incidence of gastric cancer peritoneal metastases is high,and the prognosis is poor,with a median survival time often less than one year.Currently,the diagnosis of peritoneal metastases primarily relies on imaging tests,but diagnosing occult peritoneal metastases remains challenging.Laparoscopic exploration not only allows direct visualization of metastatic lesions but also enables histological and cytological examinations,making it a routine method for diagnosing gastric cancer peritoneal metastases.The treatment of gastric cancer peritoneal metastases is a hot research topic.Due to the presence of the plasma-peritoneal barrier,systemic therapy alone has limited efficacy for gastric cancer peritoneal metastases,and in recent years,various intraperitoneal local treatments have gained increasing attention.Treatments represented by neoadjuvant intraperitoneal and systemic chemotherapy(NIPS)have shown promise in improving symptoms for some gastric cancer peritoneal metastases patients with moderate ascites,converting them to a resectable state,and ultimately prolonging survival.Selecting appropriate treatment methods and timing based on the severity of gastric cancer peritoneal metastases remains a focus of future research.

关 键 词：胃癌 腹膜转移 腹腔积液 腹腔灌注化疗 

分 类 号：R6[医药卫生—外科学]