进展期胃癌不同切除术式对辅助化疗耐受性的影响

目的比较不同胃癌根治术式对术后辅助化疗耐受性及完成率的影响。方法回顾性观察不同术式对进展期胃癌病例术后辅助化疗的影响,比较严重不良反应发生率、化疗终止原因、内镜下反流性食管炎发病率及吻合口病变情况。结果 327例可切除的局部进展期胃癌患者,其中全胃切除术式81例,近端胃切除85例,远端胃切除161例;术后化疗完成率分别为40.7%,21.2%及36.6%。近端胃切除组化疗严重不良反应发生率为48.2%,明显高于其他两组,差异有统计学意义(P<0.05)。导致近端胃切除组化疗不耐受的原因中,消化道不良反应所占比例为43.3%,尤其是呕吐反应的发生率为35.8%,明显高于其他两组,差异有统计学意义(P<0.05)。近端胃切除组反流性食管炎及吻合口溃疡的发生率亦明显高于其他两组,差异均具有统计学意义(均P<0.05)。结论近端胃切除组病例术后化疗不良反应发生率高,化疗完成率低,而全胃切除术后辅助化疗耐受相对好,化疗完成率高,可提高胃上部癌的治愈率并降低复发率。

The effect of different surgical methods for gastric cancer on adjuvant chemotherapy tolerance

Objective To examine the difference of the effct of different surgical methods for gastric cancer on adjuvant chemotherapy tolerance and completion rates. Methods Retrospectively research the influence （~f different surgical methods for 327 patients of advanced gastric cancer on postoperative chemotherapy, observe the incidence of serious adverse effects, the cause of the termination of chemotherapy, the incidence of reflux esoph- agitis and the anastomotic lesions by endoscopic observation. Results 327 patients with resectable locally ad- vanced gastric cancer patients, included 81 cases of total gastrectomy, 85 cases of proximal gastrectomy, 161 ca- ses of distal gastrectomy. The completion rates of postoperative chemotherapy of three groups were respectively 40.7% , 21.2% , 36.6% , and the incidence of serious adverse reaction of proximal gastrectomy group was 48.2% which was much higher than the other two groups. Gastrointestinal adverse reactions rate was accounted for 43.3% , especially the vomiting reaction rate which was higher than the other two groups reached 35.8% a- mong all the causes of chemotherapy intolerance. The incidence reflux esophagitis and anastomotic ulcer in prox- imal gastrectomy group was also higher than the other two groups, and all the differences had statistical signifi- cance. Conclusions Proximal gastrectomy group get higher incidence of postoperative chemotherapy side effects but lower chemotherapy completion rate. However, total gastrectomy group get higher chemotherapy com- pletion rate and lower incidence of chemotherapy side effects.