进展期胃癌患者的围手术期化疗

近40年来，人们一直在研究手术以外的方法以提高胃癌的治疗效果并改善患者的预后。对于可以手术切除的进展期胃癌患者．化疗药物在改善疗效和安全性方面使其在逐步受到关注，并成为近年来胃癌综合治疗的研究热点。     

淋巴化疗联合腹腔化疗治疗进展期胃癌的临床观察

研究表明,活性碳吸附抗癌药物在进展期胃癌的腹腔化疗和淋巴化疗中取得了较好的疗效,但对两者联合应用的临床研究报道较少。为此,我们设计了下述临床随机研究,以期阐明两者联合应用对进展期胃癌的疗效。     

进展期胃癌的综合治疗

在全球范围内,胃癌发病率占恶性肿瘤第四位,每年新发病例近百万人;死亡率居恶性肿瘤第二位,每年因胃癌死亡人数超过七十万人［1］。而我国又是一个胃癌发病率和死亡率都很高的地区,严重威胁我国人民的生命健康。     

胃癌围手术期营养治疗

正2008年WHO报告,世界范围内胃癌的发病率逐渐下降,由1975年的第1位肿瘤下降为2008年的第4位~([1])。但是,中国胃癌的发病率仍然在上升,它是我国的第2位的肿瘤。我国胃癌的发病数与病死数均接近全球胃癌患者数的一半,超过世界平均水平的两倍,住院胃癌患者中超过九成是中晚期患者,5年生存率不到五分之一。     

高龄胃癌的围手术期处理

目的 探讨高龄胃癌围手术期的处理。方法 回顾分析了49例70岁以上高龄胃癌的术前准备、手术方式及术后处理。结果 高龄胃癌患者多数有其他合并症，本组行根治性胃大部切除术33例，根治性全胃切除术3例，姑息性切除8例，仅行胃肠吻合或探查5例。术后10例出现并发症，围手术期死亡3例。结论 正确的围手术期处理是减少高龄胃癌病人术后并发症和死亡率的关键因素。     

胃癌患者围手术期营养支持的研究

３４例胃患者随机分为两组（每组１７例），肠内营养组（ｅｎｔｅｒａｌ ｎｕｔｒｉｔｉｏｎ，ＥＮ组）和肠外营养组（ｐａｒｅｎｔｅｒａｌ ｎｕｔｒｉｔｉｏｎ，ＰＮ组）。围手术期给予等热卡屡量的营养支持，术前进行７￣１０天的营养支持，术后３￣１０天经不同途径进行营养支持。结果，术后１０天两组血清转铁蛋白（ＴＦ）、前白蛋白（Ｐｒｅａｌｂ），纤维连续蛋白（ＦＮ）水平均显著提高（Ｐ〈０．０５或Ｐ〈０．０１），术     

胃癌病人围手术期营养支持治疗

胃癌病人容易出现营养不良,除了癌消耗营养物质、释放引起代谢紊乱的毒素等直接影响以外,胃癌还会通过影响机体的消化吸收功能导致营养不良。营养不良增加了手术并发症的发生率,制约着辅助治疗的实施,影响总体存活率。不同生长方式、不同分期、不同位置的胃癌,营养不良的成因中直接因素与间接因素所占比例各不相同,需要区别对待。营养支持是打破肿瘤和营养不良间恶性循环的关键,为实施有效的治疗创造机会。肠内营养与肠外营养各有其优缺点,都是有效的营养治疗手段,应根据病人的具体情况个体化选择应用。在营养支持基础上针对肿瘤进行动静脉结合的术前化疗,可以使肿瘤直接影响减轻的同时,消化道梗阻等症状也得到缓解,造成营养不良的两大因素均得到控制,有效地纠正病人的营养不良。因此,营养支持和辅助治疗均是胃癌综合治疗的重要组成部分,相辅相承。     

胃癌根治术围手术期的护理

目的 :对 73例胃癌进行围手术期的护理。方法 :术前加强心理护理、饮食营养和训练各种有益的适应能力 ;术后各项生命体征监测、有效胃肠减压及并发证预防的系统化整体护理措施。结果 :全部病例度过安全期。结论 :心理护理和营养支持、胃肠减压及预防并发证的系统化整体护理提高了胃癌根治术围手术期的护理质量 ,取得满意的临床治疗效果。     

围手术期化疗与术后化疗对行手术切除晚期胃癌病人预后影响对比研究

目的 研究围手术期化疗与术后化疗对行手术切除晚期胃癌病人的预后影响。 方法 回顾性分析2004年1月至2016年12月南方医科大学南方医院普通外科行胃切除手术治疗的Ⅳ期胃癌病人资料。其中,行手术切除联合术后辅助化疗228例（术后化疗组,A 组）,行术前化疗+手术切除+术后化疗49例（围手术期化疗组,B组）。采用倾向得分匹配法（PSM）均衡组间混杂因素的影响,选取8个协变量进行1∶1匹配 (性别、年龄、肿瘤生物学分类、化疗完成度、术后病理的肿瘤浸润深度分期、淋巴结转移分期、淋巴结清扫范围、胃切除范围),最终49例A组病人和49例B组病人成功进行匹配。采用Kaplan-Merier法进行生存分析,应用Cox比例风险回归模型对行手术切除的晚期胃癌病人进行独立生存危险因素的分析。 结果 匹配前,两组病人的肿瘤生物学分类（P<0.001）、化疗周期（P<0.001）、肿瘤浸润深度分期（P<0.001）、淋巴结转移分期（P=0.049）、淋巴结清扫范围（P=0.001）、胃切除范围（P=0.001）等差异有统计学意义,而匹配之后,仅有化疗完成度（P<0.001）在两组间差异有统计学意义,B组的化疗完成度优于A组。匹配之后,A组中位生存时间（MST）为16个月（95%CI 10.36～21.64）,与B组MST 29个月（95%CI 17.24～40.76）之间差异无统计学意义（P=0.191）。生存单因素分析显示,生物学分类、化疗周期、淋巴结转移情况和淋巴结清扫情况等四个因素可影响行手术切除晚期胃癌病人的生存预后,进一步多因素分析提示,化疗周期≤2次,淋巴结转移、淋巴结清扫范围不足D2等3个因素为独立预后不良因素。化疗与手术的先后次序（围手术期化疗相比术后化疗）并不影响病人生存预后（HR 0.986,95%CI 0.539～1.806,P=0.964）。 结论 相比术后化疗,围手术期化疗并不是改善行手术切除晚期胃癌病人生存预后的独立因素,但能够使病人有更好的化疗耐受性和依从性,从而使其生存显著优于术后开始化疗的病人。这可为后续晚期胃癌治疗的前瞻性研究设计提供参考和指导。     

Combined treatment with by-pass operation,irradiation and immunochemotherapy for advanced thoracic esophageal cancer

Based on the experimental results that operative stress of thoracotomy or laparothoracotomy has enhanced tumor growth remarkably in rats compared with laparotomy, a new combined treatment with by-pass operation, irradiation and immunochemotherapy was investigated in 39 advanced thoracic esophageal cancer patients. At by-pass operation, abdominal esophagus was divided and its proximal stump was closed immediately. Cervical esophagus was then divided and its distal stump was pulled out to the right supraclavicular region to make outer fistula. Thus, anticancer drug was poured into the esophagus through outer fistula very easily just before irradiation and then irradiation was performed under the condition that the lesion was immersed in the drugs. As anticancer agent, Mitomycin-C, 5-Fluorouracil or Bleomycin was given alternately. Lately, the combination of 5-Fluorouracil and Vitamin A was preferably used. The changes of immunological parameters and the survival after the onset of treatment was reported. Supported in part by Grant-in-Aid for Cancer Research from the Ministry of Education, Science and Culture.     

阿霉素磁液术前靶向化疗对进展期胃癌细胞凋亡和增殖的影响

目的 研究进展期胃癌术前给予阿霉素磁液靶向化疗后，胃癌组织中细胞凋亡与增殖状态的变化。方法 随机选择３０例进展期胃癌，术前２周给予阿霉素磁液靶向化疗，应用脱氧核糖核酸末端转移酶介导的ｄＵＴＰ缺口末端标记法（ＴＵＮＥＬ法）和增殖细胞核抗原（ＰＣＮＡ）免疫组织化学染色法，分别检测化疗前后胃癌组织及癌周正常粘膜组织中细胞凋亡指数（ＡＩ）与增殖细胞核抗原的指数（ＰＩ）。结果 术前阿霉素磁液化疗对正常粘膜组     

The effectiveness of Appleby's operation in advanced gastric carcinoma

This study was undertaken in order to evaluate the effectiveness of Appleby's operation on the postoperative survival rate as compared with that of conventional total gastrectomy accompanying pancreatosplenectomy and that of subtotal gastrectomy with lymph node dissection of the conventional style preserving the spleen and the pancreas. In our study Appleby's operation was performed in 65 cases and the conventional procedures were in 41 cases and 50 cases, respectively. Both groups have almost identical prognostic backgrounds except for the lymph node status. The overall 5-year survival rate of Appleby's procedure group was higher (49.5%) than that of the conventional procedure group (23%) in spite of higher percentage of positive rate of the 2nd group of lymph node(n2+) in Appleby's procedure group. Furthermore, in the cases with serosal invasion(se) and positive metastasis in the 1st group of lymph node (n1+), the 5-year survival rate of Appleby's procedure group was higher (64%) than that of the conventional procedure group (32%), and the difference was statistically significant (p less than 0.01). On the other hand, no difference was observed in the 5-year survival rate between both groups in which the serosae were invaded and the 2nd group of lymph nodes were involved. Our study shows that Appleby's procedure salvaged further 32% of patients that would have been lost if they had undergone the conventional procedure.     

Post-operative long-term adjuvant immunochemotherapy with mitomycin-C,PSK and FT-207 in gastric cancer patients

Long-term adjuvant immunochemotherapy carried out on the gastrectomized patients with stomach cancer was reported. The protocol comprises the administration of large-dose of Mitomycin-C (20+10) mg just after gastrectomy and the long-term administration of PSK, FT-207 or (PSK+FT-207). Almost no side effects were observed. According to the studies on the immunological parameters, the increased reactions in PPD skin test and lymphocyte blastogenesis induced by PHA and PWM were observed remarkably in group (P+F) 3 or 6 months after gastrectomy. As for the survival rate, group (P+F) showed the most preferable results at one year in stage IV, at two years in stage III and at three years in all the stages, respectively after gastrectomy. Supported in part by Grant-in-Aid for Cancer Research from the ministry of Health and Welfare.     

Clinical evaluation of schizophyllan adjuvant immunochemotherapy for patients with resectable gastric cancer —A randomized controlled trial—

Adjuvant immunochemotherapy using schizophyllan (SPG), an extract from the culture broth ofSchizophyllum commune Fries, was prescribed at random for 326 Japanese patients with resectable gastric cancer. The overall survival rates for 3 years did not differ between the SPG and control groups. In 62 patients with stage I gastric cancer and 67 with stage II, there was little difference in the 3-year survival rates. The survival rates for 100 patients with stage III were enhanced at p=0.0811 in the SPG group, as compared to the controls. The survival rates in 97 patients with stage IV cancer were much the same. These results warrant further application of this immunopotentiating drug for treating patients with resectable gastric cancer.     

胃癌术前螺旋CT分期的临床意义

目的:探讨胃癌术前人工气腹法螺旋CT(induccd pneumo-peritoneurn in spiral CT,SCTPP)检查对胃癌术前分期,选择治疗方案、确定手术方式的临床意义。方法;进展期胃癌52例先后进行常规SCT和SCTPP检查,检查结果与手术后病理结果进行对照。结果:常规SCT和SCTPP对T分期的准确性分别为72.3％和95.7％(P<0.05),对M分期的敏感性分别为61％和100％(P<0.05),二者均不能准确提供淋巴结转移情况。结论:SCTPP对术前判断胃癌局部病变情况及远处转移的准确性明显高于常规SCT,对选择治疗方案、确定手术方式具有重要的参考价值。     

Postoperative adjuvant immunochemotherapy with mitomycin C,futraful and PSK for gastric cancer. An analysis of data on 579 patients followed for five years

In order to evaluate the combination of immunochemotherapy with mitomycin C (MMC), futraful (FT) and PSK, as an adjuvant to surgery for curatively resected gastric cancer, a randomized controlled study by the sealed envelope method was performed with the participation of 97 hospitals in the Kyushu and Chugoku districts of Japan. The MMC+FT+ PSK group showed a significant increase in 5 year survival from the other groups (p<0.05). Moreover the survival rate was significantly higher in the MMC+FT+PSK group than in the MMC+FT group (p<0.01). According to the analysis on stratification, the MMC+FT+PSK group showed the best survival rate in cases with positive lymph node metastases, positive serosal invasion and positive lymph node metastases plus serosal invasion, and in cases of undifferentiated carcinoma by histological type and in those with a preoperative positive PPD reaction (p<0.01 or p<0.05). Thus, the combination of MMC, FT and PSK was indicated to be useful as an adjuvant immunochemotherapy for those patients with gastric cancer submitted to curative resection. The Co-operative Study Group of Surgical Adjuvant Chemotherapy for Gastric Cancer     

Bypass operation for advanced esophageal cancer —An analysis of 93 cases—

From 1973 to 1987, 235 patients with esophageal squamous cell carcinoma were treated at Hiroshima University. Of these patients, 121 (51.5 per cent) were submitted to esophagectomy, 93 (39.6 per cent) to bypass surgery and 21 (8.9 per cent) to either exploratory or no surgery. In this report, the 93 cases who underwent bypass surgery were analysed. Ten patients died within thirty days after their operation (10.8 per cent) and there were 33 cases of hospital death (35.5 per cent). Following the bypass surgery, 49 (59.0 per cent) cases were able to tolerate over 50 per cent of their normal oral intake and 22 cases (26.5 per cent) were able to tolerate between 25 per cent and 50 per cent. For twelve cases (14.6 per cent), however, oral ingestion proved impossible up until the time of death due to such complications as leakage. The overall survival rates were 44.3 per cent at 6 months, 12.7 per cent at 1 year and 2.8 per cent at 5 years, respectively. Two cases survived for over 5 years. Hyperthermia was applied in combination with chemotherapy from 1981, however, no case survived for over one year without radiation therapy. Recently, radiation plus hyperthermia is being performed in combination with immunochemotherapy.     

膀胱癌患者手术前后机体氧化应激改变及意义

目的探讨膀胱癌患者手术前后机体氧化应激变化及临床意义。方法 173例膀胱癌患者入选研究,其中移行上皮癌163例,腺癌5例,鳞癌4例,肉瘤1例;非肌层浸润性膀胱癌121例,肌层浸润性膀胱癌52例。分别检测手术前后患者血清VitC、VitE、超氧化物歧化酶（SOD）、谷胱苷肽过氧化物酶（GPx）、丙二醛（MDA）、总抗氧化活性（AOA）等。结果非肌层浸润性膀胱癌患者血清VitC、VitE、SOD、GPx均明显低于肌层浸润性膀胱癌,P〈0.05,MDA含量高于肌层浸润性膀胱癌,P〈0.05。手术后患者血清VitC、VitE、SOD、GPx、AOA均明显高于手术前（P〈0.05）,但MDA含量明显低于手术前（P〈0.05）。结论膀胱癌患者机体氧化应激随其恶性程度升高而升高,手术治疗后机体氧化应激水平降低。