淋巴结阴性进展期胃癌复发的模式和影响因素的回顾性研究

目的探讨淋巴结阴性进展期胃癌根治性切除术后发生复发的模式和影响因素,用以评估预后和改进治疗策略。方法对2000—2006年淋巴结阴性并且接受根治性切除术的590例进展期胃癌患者的临床病理特征和预后进行回顾性评价。结果在纳入研究的590例患者中,有28例（4．7％）发生局部复发,10例（1．7％）发生淋巴结复发,52例（8．8％）发生腹膜种植转移,41例（6．9％）发生血行转移。通过多因素分析我们发现,肿瘤最大直径（P=0．021）,组织学类型（P=0.000）和Borrmann分型（P=0．035）是影响局部复发的独立性因素。淋巴结清扫术（P=0．033）和脉管浸润（P=0．006）对淋巴结复发有显著影响。影响腹膜种植转移的临床病理因素有浸润深度（P=0．000）和Borrmann分型（P=0．004）。此外,脉管浸润（P=0．015）和组织学类型（P=0．000）与血行转移有显著相关性。结论淋巴结阴性进展期胃癌更容易发生腹膜种植转移和血行转移。     

整合素αvβ3与胃癌腹膜转移机制的研究进展

胃癌是我国常见的消化道恶性肿瘤之一，虽然采取广泛淋巴结清扫的胃癌根治术，但术后5年生存率仅35％左右。腹膜转移是术后复发转移的常见方式。献报道嘲在胃癌术后复发的诸类型中，腹膜种植性复发占50％以上，且系多数复发患致死的直接因素，目前胃癌腹膜种植转移的机制尚不十分清楚，但多数认为是胃癌腹膜种植性播散，胃癌腹膜种植性播散主要来源于腹腔游离癌细胞或微转移灶，其途径是癌细胞浸润出胃壁浆膜层并脱离癌组织母体进入腹腔，成为有生物活性的脱落癌细胞，粘附于腹膜并增殖形成种植转移灶，即细胞的脱落、附着、增殖3个阶段，研究显示：E-钙粘素、β1整合素在癌细胞脱落、附着过程中发挥重要作用，在增殖阶段，整合素中的某些亚家族与其配体结合，造成癌细胞侵袭处的腹膜组织炎症反应、毛细血管形成，新形成的毛细血管提供了癌灶所需的营养，使癌细胞继续增殖，成为了腹膜种植转移结节。而新生血管生成过程所依赖的血管内皮细胞增殖、迁移和侵袭均受到细胞粘附分子受体的调控，整合素αvβ3受体在其中发挥重要作用。[第一段]     

进展期胃癌术后患者行腹腔化疗的护理

腹膜转移是影响胃癌患者预后的重要因素之一,而腹腔脱落癌细胞（ECC）又是腹膜种植性转移的成因。因此,针对杀灭ECC的术后辅助治疗手段逐渐引起了国内外的重视,如腹腔温热低渗液灌洗、腹腔化疗和生物治疗等。护理程序对护士来讲是一种科学的发现问题和解决问题的工作方法,自2004年始,江苏省扬州市第四人民医院运用护理程序对进展期胃癌术后予腹腔化疗的患者进行护理,现将其护理心得总结如下。     

胃癌根治术中腹腔热灌注化疗对预后的影响

肿瘤腹腔内种植转移是进展期胃癌患者术后最常见的复发形式和死亡原因，腹腔内热灌注化疗（IPHP）能提高胃肠道肿瘤术后患者的生存率，尤其对胃肠道肿瘤伴有浆膜浸润、腹膜种植或肝转移者更有显效。作者自1998年1月至2003年6月对58例进展期胃癌采用在根治术中行一次性腹腔温热灌注化疗，取得了良好的临床疗效，现报告如下。     

胃癌术中应用氟尿嘧啶缓释植入剂的安全性研究

胃癌术后复发及转移是导致患者死亡的最重要原因之一,如何降低进展期胃癌术后复发,是胃肠外科医师长久追求的目标.进展期胃癌术后复发主要是由于腹腔内脱落细胞、腹膜后淋巴结和腹膜上的转移灶引起的,目前针对这些部位的化疗方法很少,效果也不甚理想.氟尿嘧啶植入剂作为一种新型给药途径的化疗药,在乳腺癌、恶性胸腔积液、结肠癌及肝癌已经开始广泛应用并取得良好疗效[1-2].我院普外科自2009年1月至2011年6月对42例进展期胃癌患者进行胃癌根治术,随机分为术中植入氟尿嘧啶植入剂组和空白对照组,观察植药后白细胞及丙氨酸氨基转移酶(ALT)、胆红素和肌酐变化,两组患者胃肠道功能恢复时间,腹腔引流液、切口愈合情况及,吻合口瘘的发生率,为预防进展期胃癌术后复发探索新途径.     

进展期胃癌术后腹腔灌注化疗的临床疗效观察

胃癌术后化疗在近10余年来一直受到学者的关注，目前认为其对杀灭脱落癌细胞、亚临床病灶等有临床意义，对提高术后无病生存率及总生存率有益。有报道认为，腹腔内温热化疗能预防胃癌患者术后腹膜转移的发生。因此，浙江省人民医院外科自2001年6月至2002年6月，对65例Ⅱ～Ⅳ期胃癌患者实行胃癌根治手术，术后随机分为两组，分别予腹腔灌注化疗联合静脉化疗和常规静脉化疗患者进行对比研究，报道如下。     

T4a期胃癌患者行微创手术后的生存状况与长期效果研究

目的探究T4a期胃癌患者行微创手术后的生存状况与长期效果。方法回顾性分析2010年1月-2013年1月该院收治的93例T4a期胃癌患者的临床资料,所有患者均行腹腔镜T4a期胃癌根治术治疗,术后经门诊、电话等方式进行随访,其中5例患者失访,以未失访的88例患者作为研究对象。分析患者5年生存状况,其中49例患者存活为存活组,39例患者死亡为死亡组。对T4a期胃癌患者行微创手术后死亡相关因素进行单因素和Logistic多因素分析。结果术后5年内48.86%(43例)患者无病生存;6.82%(6例)患者带瘤生存,44.32%(39例)患者死亡,其中39.77%(35例)患者因复发或转移死亡。单因素分析结果显示,肿瘤直径、肿瘤部位、联合脏器切除、肿瘤N分期、Lauren分型、淋巴结转移率、淋巴结转移范围、淋巴结转移数目与T4a期胃癌患者行微创手术后死亡有密切相关性(P0.05)。Logistic多因素分析结果显示,联合脏器切除、肿瘤N2分期、淋巴结转移率40%、淋巴结转移范围大、淋巴结转移数目多为T4a期胃癌患者行微创手术后死亡的危险因素(P0.05)。结论 T4a期胃癌患者行微创手术后5年生存状况不佳,联合脏器切除、肿瘤N2分期、淋巴结转移率40%、淋巴结转移范围大、淋巴结转移数目是其术后死亡的危险因素,应对此类患者加强监测,以改善预后。     

不同浆膜分型胃癌与腹膜转移的关系

目的：探讨胃癌不同浆膜分型对预测术后腹膜转移的临床价值。方法：对1 825例不同浆膜分型（正常型130例,苔状型77例,结节型553例,腱状型433例,反应型241例,多彩弥漫型389例）胃癌患者与腹膜转移关系进行对比分析。结果：不同浆膜分型腹膜转移总体差异有统计学意义（P〈0.001）,腱状型与多彩弥漫型转移率高于其他型差异有统计学意义（P〈0.05）,腱状型与多彩弥漫型之间差异无统计学意义（P〉0.05）。结论：浆膜分型腱状型与多彩弥漫型易发生腹膜转移,浆膜分型可以作为胃癌术后预测腹膜转移的指标。     

胃癌的腹腔内种植性转移与术后早期腹腔内化疗

胃癌居我国恶性肿瘤发病率和病死率之首,多数病例在确诊时已属中、晚期,手术治疗的5年生存率为20％～30％[1]。其主要死亡原因是术后切除部位、腹膜、肝脏的复发和转移,如何预防和治疗这些部位的复发和转移提高胃癌患者远期生存率的关键问题之一。国内外学者对此进行了大量的研究,证实术后早期应用腹腔内化疗（intraperitonealchemotherapy,IPC）疗效较好,现综述如下。1胃癌腹腔内种植性转移的机理胃癌的腹腔内种植性转移有两种形式,一是自发性种植转移,二是术中医源性种植转移。胃癌侵犯浆膜后,随着正常的胃肠蠕动和呼吸运动,…     

胃癌根治术后复发区域的研究

目的分析胃癌根治术后复发区域及规律,初步探讨术后放疗范围。方法回顾分析2005年1月—2006年12月胃癌术后复发的220例病人的临床资料,总结复发区域与肿瘤原发部位的关系。结果胃癌原发部位不同,其术后复发区域不完全相同,22例胃底贲门部癌腹膜后淋巴结复发20例,局部复发4例;54例胃体部癌腹膜后淋巴结复发40例,局部复发4例;144例胃窦部癌腹膜后淋巴结复发110例,肝脏转移48例。结论胃癌根治术后放疗靶区应包括腹膜后淋巴结引流区。     

Molecular targeting therapy using bevacizumab for peritoneal metastasis from gastric cancer

AIM: To clarify the significance of vascular endothelial growth factor (VEGF) in peritoneal metastasis from gastric cancer, using the gastric cancer cell line MKN-45 compared with the high potential peritoneal dissemination gastric cancer cell line MKN-45P.METHODS: The supernatant of culture medium of MKN-45 cells or MKN-45P cells was collected and the concentrations were measured of various cytokines, matrix metalloproteinases, growth factor and angiogenic factors, including VEGF. We performed an initial pilot study to explore whether bevacizumab, a humanized monoclonal antibody against VEGF, had any suppressive effect on the peritoneal dissemination from gastric cancer in an experimental nude mouse model of peritoneal metastasis.RESULTS: The concentrations of interleukin-6 (IL-6), IL-8, VEGF and matrix metalloproteinase-2 protein in the culture supernatant were each significantly higher than each of those for MKN-45. In the in vivo study, the volume of ascites and the mitotic index were significantly lower in the therapy group than in the non-therapy group. The survival curve of the therapy group was significantly higher than that of the non-therapy group. These results suggested that VEGF was correlated with peritoneal metastasis from gastric cancer.CONCLUSION: Findings suggested that bevacizumab for inhibiting VEGF could suppress peritoneal dissemination from gastric cancer.     

Efficacy of S-1 for patients with peritoneal metastasis of gastric cancer

BACKGROUND: This study was designed to examine the efficacy and compliance of S-1 for the patients with peritoneal metastasis of gastric cancer. METHODS: Sixteen consecutive patients with peritoneal metastasis of gastric cancer were treated with S-1. Their survival was compared with that of the historical control group (25 patients). Thymidylate synthase, dihydropyrimidine dehydrogenase, thymidine phosphorylase and orotate phosphoribosyl transferase mRNA expression in the tumor were evaluated. RESULTS: The median survival time of S-1-treated patients was 550 days, which was significantly longer than that of the historical control group (215 days). We elucidated some factors to prolong the survival of the patients treated with S-1 for peritoneal metastasis: peritoneal metastasis without other distant metastases, the combination of S-1 treatment and gastrectomy, and low expression of thymidine phosphorylase mRNA in primary tumors. Conclusions: S-1 showed a surprisingly long-term survival with minimum toxicity in patients with peritoneal metastasis of gastric cancer.     

榄香烯预防胃癌HGC－27裸鼠腹腔转移的研究

目的：研究榄香烯对胃癌HGC-27裸鼠腹膜种植转移的预防作用。方法：建立人胃癌HGC－27腹膜转移裸鼠模型,分别给与榄香烯、顺铂（DDP）及两者联合进行干预后,检测腹膜转移瘤腹膜肿瘤指数,并用免疫组织化学法检测转移瘤组织中增殖细胞核抗原Ki67、抗凋亡蛋白bcl－2的蛋白表达情况。结果：与对照组比较,榄香烯、DDP及榄香烯联合DDP干预组的腹膜转移瘤PCI指数均显著降低,其中以联合治疗组PCI指数降低最为显著（PCI指数为33,P〈0．01）。同时,上述3种干预组转移瘤组织中Ki67、bcl－2蛋白阳性表达率显著降低,其中以联合治疗组Ki67、bcl－2蛋白阳性表达率降低最为显著（57．14％和34．28％,均P〈0．05）。结论：榄香烯单独或者联合DDP应用对于人胃癌HGC－27裸鼠腹腔转移有显著的预防作用。     

The clinical status and histopathological factors affecting natural killer cells of peripheral blood lymphocytes in patients with gastric cancer.

The in vivo function of NK cells is still uncertain, and there are various contradictory reports on NK cells in gastrointestinal cancer. In the present study the activity and proportion of NK cells (Leu 11 + cells) in peripheral blood were assessed in 71 patients with gastric cancer, and analysed with respect to the clinical and histopathological factors, such as the clinical stage, tumor size, degree of invasion, metastasis, histology, etc. There were no differences in the proportions and activities of NK cells between normal volunteers and gastric cancer patients. A low NK cell activity was associated with early gastric cancers (carcinoma in the mucosa or submucosa) less than 2 cm in diameter, large advanced tumors (invasion beyond the muscularis propria) greater than 8 cm in diameter, and metastasis of adjacent regional (perigastric) nodes. Liver metastasis did not affect the NK cell activity, however a high NK activity was found in patients with peritoneal dissemination. The NK activity did not correlate with the proportion of Leu 11 + cells in normal volunteers or in patients with early gastric cancer, however the activity and proportion of NK cells correlated with each other in patients with advanced gastric cancer. These results suggest that the preoperative evaluation of circulating NK cells in gastric cancer patients may be beneficial to assess the extent of nodal metastasis, the degree of tumor invasion, and peritoneal dissemination.     

胃癌患者血清胸苷磷酸化酶表达与临床病理特征、化疗疗效及预后关系的研究

目的探讨晚期胃癌患者血清胸苷磷酸化酶(TP)水平与临床病理特征及以氟尿嘧啶为基础的化疗疗效和预后的关系。方法选取2010年1月至2012年6月于北京友谊医院消化内科接受治疗的晚期胃癌患者化疗前血清,用酶联免疫吸附试验(ELISA)方法检测血清中TP表达水平。结果血清TP表达水平与性别、年龄、组织分化程度、KPS评分、肝转移及淋巴结转移无明显相关,腹膜转移患者的TP表达水平显著低于无腹膜转移患者(P=0.017),TP高表达患者与低表达患者的临床获益率无显著差异,但TP高表达患者的无进展生存期(PFS)和总生存期(OS)均长于低表达患者(PFS:177 d vs.106 d,P=0.067;OS:417 d vs.222 d,P=0.002)。结论在接受氟尿嘧啶为基础的化疗的胃癌晚期患者中,血清TP高表达的患者预后较低表达患者好。     

Adopting extensive intra-operative peritoneal lavage (EIPL) as the standard prophylactic strategy for peritoneal recurrence

EIPL (extensive intra-operative peritoneal lavage) therapy was developed as a prophylactic strategy for peritoneal recurrence, with the goal of improving the quality of life and survival span for advanced gastric cancer patients with peritoneal free cancer cells. The purpose of this article is to review the therapy's contribution to a remarkable improvement in the 5-year survival for patients with positive lavage cytology on prospective randomized controlled clinical trials. We also advocate for the adoption of the EIPL as the optimal treatment protocol for advanced gastric cancer.     

胃癌患者围手术期危险因素分析

目的调查与胃癌根治术有关的危险因素。方法对92例行胃癌根治术的患者进行统计分析,调查可能导致住院期死亡和手术并发症的因素。结果年龄〉65岁、术前白蛋白〈35g、血红蛋白〈80g／L、腹水量〉300ml、有合并症、联合切除脾/胰、手术方式为全胃切除术等7个因素是胃癌根治术的危险因素。结论在准备胃癌根治术时,以上危险因素应仔细考虑,有目的地控制以上因素可以降低胃癌根治术的并发症发生率,减少病死率。     

食管癌患者术后胃潴留的影响因素分析

目的探讨食管癌患者术后胃潴留的影响因素并提出预防措施。方法选择2017年4月至2019年4月我院食管癌手术患者80例作为研究对象,术后给予肠内营养支持,发生胃潴留患者25例。分析影响食管癌患者术后胃潴留的因素,采用多因素logistic回归分析,确定食管癌患者术后胃潴留的危险因素。结果多因素logistic回归分析显示,机械通气、低钾血症、便秘、合并糖尿病、肠鸣音减弱是食管癌术后肠内营养胃潴留的独立危险因素。结论食管癌术后肠内营养支持期间易发生胃潴留,受到机械通气、低钾血症、便秘等因素的影响,可针对胃潴留高危患者开展针对性防治措施以降低胃潴留风险发生率。     

Uneven haustra on CT colonography: a clue for the detection of transperitoneal invasion from gastric cancer

Two patients with gastric carcinoma underwent CT colonography (CTC) for preoperative work-up. Although no obvious peritoneal nodules were seen on axial CT images, colonic wall deformities were noted on three-dimensional (3D) air images. Multiplanar-reformatted images revealed corresponding colonic wall thickening at the deformities, and in addition, dense cordlike structures connecting the primary gastric cancer and colonic wall thickening were also observed. In one patient, cordlike indurations consistent with peritoneal invasion were found to connect the primary gastric cancer, gastrocolic ligament, and transverse mesocolon during exploratory surgery, and in the other, colonic scars consistent with peritoneal invasion after chemotherapy were observed. These observations suggest that CTC could be of potential use for the differentiation of transperitoneal colonic invasion and gastric cancer.     

Condition mimicking peritoneal metastasis associated with preoperative staging laparoscopy in advanced gastric cancer

Preoperative staging laparoscopy is used to search for peritoneal dissemination or distant metastasis as part of the treatment strategy for advanced gastric cancer. We observed pseudo‐peritoneal metastasis during laparotomy in 6 of 49 patients in whom lack of peritoneal dissemination had been confirmed by preoperative staging laparoscopy. In all cases, suspected nodules were biopsied and subjected to rapid histological diagnosis. However, a definite malignant or benign diagnosis could not be obtained via a rapid histological examination during surgery. A final histological examination combined with immunohistological analysis using formalin‐fixed embedded tissues confirmed no malignancy after surgery in all cases. These rapidly growing nodules that mimic peritoneal metastasis are thought to be associated with the use of grasping forceps during staging laparoscopy. No cases have been reported in which peritoneal nodules mimicking peritoneal metastasis occurred after staging laparoscopy, and surgeons should consider this possibility in patients treated shortly after staging laparoscopy.