新辅助化疗联合腹腔镜手术治疗进展期胃癌的临床研究

目的评价术前新辅助化疗联合腹腔镜手术治疗进展期胃癌的疗效。方法应用改良FOLFOX4方案对42例进展期胃癌患者施行术前新辅助化疗,然后行腹腔镜手术治疗。结果全组患者各种化疗毒副反应较低,均可耐受化疗。新辅助化疗后23例（54.8%）肿瘤再分期降低,临床完全缓解（CR）6例（14.3%）,部分缓解（PR）26例（61.9%）,疾病稳定（SD）6例（14.3%）,进展（PD）4例（9.5%）,总有效率（RR）为76.2%（32/42）。疗程结束后1～2周行腹腔镜手术治疗,37例（88.1%）切除肿瘤,25例（59.5%）获根治性切除,8例（19.0%）相对根治切除,4例（9.5%）行姑息性手术;5例（11.9%）仅行腹腔镜探查未切除肿瘤。结论术前新辅助化疗联合腹腔镜手术治疗进展期胃癌疗效显著,有效率高,显著提高了手术切除率且不良反应轻,耐受性良好,并可发挥腹腔镜手术创伤小、恢复快的微创优势。

The clinical research of neoadjuvant chemotherapy combined with laparoscopic surgery for advanced gastric cancer

Objective To evaluate the efficacy of neoadjuvant chemotherapy combined with laparoscopic surgery for advanced gastric cancer patients.Methods 42 patients with advanced gastric cancer were treated with improved FOLFOX regimen as neoadjuvant chemotherapy,and then received laparoscopic surgery.Results All patients can tolerate the chemotherapy and the toxicities of chemotherapy were low.The tumor stage were downstaged in 23 cases（54.8%） after neoadjuvant chemotherapy,the clinical complete response（CR）occurred in 6（14.3%）patients,partial response（PR）in 26（61.9%）,stable disease（SD）in 6（14.3%）,and progressive disease（PD）in 4（9.5%） patients,the overall response rate（RR）was 76.2%（32/42）.All patients received laparoscopic surgery in one to two weeks after treatment,37 patients（88.1%） removed the tumor,25 patients（59.5%） received radical resection,8 patients（19.0%） relatively radical resection,4 cases（9.5%） palliative surgery;5 cases（11.9%） underwent laparoscopic but didn＇t remove the tumor.Conclusion The preoperative neoadjuvant chemotherapy combined with laparoscopic surgery for advanced gastric cancer had a significant effect and a high efficiency,significantly improved the resection rate and the adverse reaction was mild and well tolerated,it also play surgical trauma,quicker recovery advantages of laparoscopic surgery.