胃癌外科治疗的新进展及发展趋势

胃癌严重威胁人类健康,尽管近年来化疗、靶向治疗和免疫治疗等新型药物研发不断取得突破,但根治性手术始终是胃癌诊疗的核心。随着标准胃癌根治手术的成型,以腹腔镜技术为代表的微创外科治疗技术的进步,进展期胃癌围手术期综合治疗模式的确定,以及胃癌精准外科理念的形成和初步实践,胃癌手术治疗取得了巨大进步。个体化和精准化胃癌外科治疗理念深入人心。安全、有效、精准、微创始终是胃癌外科医师需牢牢把握的学科发展的内在规律。为帮助年轻医师更好的成长,本文总结胃癌诊疗的最新进展,并对未来的发展趋势进行展望。     

老年胃癌合并糖尿病95例的外科治疗

目的探讨合并糖尿病的老年胃癌围手术期的处理。方法对外科治疗合并糖尿病的95例老年胃癌患者的临床资料进行回顾性分析。结果95例均行择期手术，术后共发生各类并发症27例次，手术死亡3例，其余患者均安全度过围手术期。结论严格控制血糖和尿糖是老年胃癌合并糖尿病患者安全度过围手术期的关键。     

高龄胃癌患者外科治疗分析

近20年来，老年人胃癌死亡率呈明显上升趋势，随着我国人口的老龄化及医疗水平的提高．高龄老年胃癌患者手术也日益增多．因此，对其临床特点进行分析，研究其手术风险性及围手术期处理．具有重要的临床意义。我院外科自1996年7月-2004年7月手术治疗胃癌患者1336例，其中≥70岁老年患者282例，现将其临床资料进行回顾性分析总结如下。     

胃癌放射治疗的进展

胃癌的治疗向来以外科治疗为主，但大多数胃癌患者明确诊断已处于进展期，不能通过手术治愈。目前，放射治疗在胃癌的治疗中发挥着越来越重要的作用。现就当前放射治疗在胃癌治疗中的现状进行综述。     

T_1期和T_2期胃癌的外科治疗(兼评早期胃癌的临床意义)

目的　通过分析Ｔ１ 期和Ｔ２ 期胃癌的疗效,评价外科治疗对早期胃癌的临床意义。方法　对１３２ 例接受根治性手术的Ｔ１ 、Ｔ２ 期胃癌患者的预后进行回顾性分析。结果　Ｔ１ 和Ｔ２ 期患者的肿瘤平均大小、术中淋巴结转移率、术后复发率以及术后生存率差异均有显著性,进一步分析发现,术中已有淋巴结转移的Ｔ１ 期患者的术后生存率,明显低于术中无淋巴结转移的同期患者;而术中无转移的Ｔ２ 期患者的术后生存率,与Ｔ１ 期患者的生存率相似。结论　Ｔ１ 期（ 早期）胃癌,如已有淋巴结转移,亦应施行Ｄ２ 手术;而属进展期的Ｔ２ Ｎ０ 期胃癌,由于手术治疗预后好,在考虑是否采用术后辅助治疗时可按早期胃癌对待     

腹腔镜在胃癌中的应用现状

随着微创外科的理念被引入胃癌外科领域,腹腔镜技术在胃癌诊断及治疗中得到广泛应用。腹腔镜下早期胃癌手术的治疗疗效优于传统开腹手术,并已成为标准手术方式之一,腹腔镜下进展期胃癌手术的近期疗效虽优于传统手术方式,但远期疗效仍缺乏多中心、大样本、前瞻性随机对照研究来验证。     

局部晚期胃癌围手术期免疫治疗研究进展

摘 要：胃癌是我国主要癌种之一,胃癌根治术是患者治愈的唯一机会,但只有50%～60%的初始诊断胃癌患者适合胃癌根治术,尤其是局部晚期以及晚期患者往往失去手术机会。MAGIC及ACCORD07/FFCD9703的研究结果明确了以氟尿嘧啶为主的联合化疗方案作为局部晚期胃癌围手术期治疗标准的地位。然而,胃癌患者的5年总生存率仍较低。免疫治疗在晚期胃癌一线治疗中疗效显著,同时,免疫检查点抑制剂、肿瘤疫苗、细胞疗法等免疫疗法在胃癌局部晚期患者围手术期治疗中也展现出了一定的安全性和有效性。全文就免疫治疗在局部晚期胃癌围手术期治疗中的研究进展进行综述。     

胃癌姑息外科性手术治疗的临床意义

手术治疗仍是胃癌的主要治疗措施。由于部分患者受经济因素的限制以及对胃癌早期症状缺乏认识,就诊病例多数偏晚,根治性手术治疗机会的病例较少,本文回顾分析我院１９９０年１月～１９９７年１２月行姑息性外科治疗胃癌４１例临床资料,就胃癌姑息性外科治疗的临床意义进行探讨。１　临床资料１１　一般资料　４１例胃癌病例,均为一般情况尚好,有手术探查条件,内镜及Ｘ线诊断为ＢｏｒｒｍａｎｎⅡ、Ⅲ型,术前临床分期诊断均为Ｔ３－４ＮｘＭ０的患者。男２６例,女１５例。年龄３７～７１岁。１２　术中所见及手术术式　术中所见…     

我国胃癌外科的现状与发展趋势

胃癌是我国常见的消化遭恶性肿瘤,外科手术仍然是胃癌治疗的主要手段.从Bilroth医生第一例胃大部切除至今已有120年余,胃癌外科治疗从一般的胃大部切除术进入以清除淋巴结为目的的根治术;从解剖学为基础的手术走向以解剖学、肿瘤生物学及免疫学为基础的手术;从只重视手术的安全性到根治性安全性及机能性统一;从只重视切除肿瘤到以切除原发肿瘤及受侵器官,彻底清除区域淋巴结及杀灭腹腔脱落癌细胞的外科治疗;从单一的手术进入以围手术期治疗加规范化手术的新的治疗模式.     

贲门癌、胃癌合并糖尿病的围手术期处理(附21例报告)

随着人口老龄化,恶生肿瘤及糖尿病的发病率有明显增高趋势．贲门癌胃癌是我国常见的恶性肿瘤之一,手术是当今治疗的首选方法,合并糖尿病将严重影响外科治疗。本人总结自1999年以来的21例贲门癌、胃癌合并糖尿病病人的围手术期处理的成功体会。报告如下：     

胃癌诊疗的热点和问题

我国是胃癌高发地区,发病率与死亡率在恶性肿瘤中均位居前列,受区域发展水平的制约,我国的胃癌诊治条件尚不能够完全满足众多病患的需求,面临着十分严峻的抗击胃癌形势。多学科、个体化、规范化治疗是胃癌诊治的发展趋势,目前有关胃癌的热点及争议有很多,胃癌诊治问题的解决有赖于循证医学研究的进一步发展。本文从胃癌临床分期、腹腔镜手术技术、早期胃癌的诊治、晚期胃癌转化治疗、食管胃结合部癌的治疗策略、快速康复外科、基础医学转化研究及胃癌临床试验等方面进行综述,系统地概括当前胃癌诊疗的热点和问题,希望能对广大同道起到一定的参考作用。     

胃癌的外科治疗

本文分析了东西方学者对胃癌外科治疗的分歧与近年逐渐取得共识的趋向;介绍了早期胃癌与进展期胃癌合理外科治疗的原则;近年主张早期胃癌不必切除大网膜与网膜囊.进一步确定了中、上部胃癌胰脾区清除范围,行保存一线,切除动脉干及脾的临床价值.     

胃癌诊疗的热点和问题

我国是胃癌高发地区,发病率与死亡率在恶性肿瘤中均位居前列,受区域发展水平的制约,我国的胃癌诊治条件尚不能够完全满足众多病患的需求,面临着十分严峻的抗击胃癌形势。多学科、个体化、规范化治疗是胃癌诊治的发展趋势,目前有关胃癌的热点及争议有很多,胃癌诊治问题的解决有赖于循证医学研究的进一步发展。本文从胃癌临床分期、腹腔镜手术技术、早期胃癌的诊治、晚期胃癌转化治疗、食管胃结合部癌的治疗策略、快速康复外科、基础医学转化研究及胃癌临床试验等方面进行综述,系统地概括当前胃癌诊疗的热点和问题,希望能对广大同道起到一定的参考作用。      

晚期胃癌分子靶向治疗进展

我国胃癌发病率高,由于早期临床症状不典型以及早期胃癌的筛查重视度不够,多数患者确诊时已处于疾病晚期。传统化疗一直是晚期胃癌主要的治疗选择,然而单纯化疗的疗效仍十分有限且已达到瓶颈。随着肿瘤分子生物学的研究深入,分子靶向治疗为晚期胃癌的治疗带来了新的曙光和希望。本文拟就近几年胃癌靶向治疗的新进展作一综述,分析药物的有效性和安全性,为临床治疗提供一些参考。     

Current state of treatment for advanced gastric cancer

The radical treatment of gastric cancer is complete resection of the tumor by surgery. For advanced gastric cancer, a multidisciplinary approach has been attempted to improve patient prognosis. Potentially resectable and curable advanced gastric cancer is treated with routine surgery, followed by postoperative adjuvant chemotherapy. For highly advanced gastric cancer, extended radical surgery or preoperative adjuvant chemotherapy have been attempted. Laparoscopic gastrectomy for advanced gastric cancer has not been widely used because of the difficult surgical technique involved, but enhanced magnification in the surgical field is expected to improve the accuracy of the lymph node dissection procedure. In future, the significance of currently available treatments should be investigated. The key treatment for advanced gastric cancer at present is surgery.     

Treatment strategy for early gastric cancer

Gastric cancer ranks the second leading cause of cancer-specific mortality worldwide. With a poor prognosis, 5-year survival rate of gastric cancer is less than 20%-25% in the USA, Europe, and China [1]. However, early gastric cancer(EGC) offers an excellent (over 90%) chance of cure based on surgical resection [2]. As the increasing detection of EGC, more treatment options have been developed both curatively and minimally invasively to maintain a good quality of life(QOL). One of the advanced therapeutic techniques is endoscopic dissection. Improvements in surgical treatment include minimizing lymph node dissection, reconstruction methods, laparoscopy-assisted surgery, and sentinel node navigation surgery(SNNS) [3]. With technological advances, even Natural Orifice Transluminal Endoscopy Surgery (NOTES) and robotic surgery are expected to represent the next revolution [4]. However, there still remains much dispute among these treatments, which arouses further clinical trials to verify. Update of the treatments, controversial indications, prognosis and current strategies for EGC are discussed in this review.     

局部进展期胃癌新辅助治疗的现状与未来

胃癌是中国常见的恶性肿瘤之一。目前,手术切除是可以治愈胃癌的唯一方法,然而局部进展期胃癌（locally advanced gastric cancer,LAGC）患者单纯接受手术疗效较差,术后复发风险较高。新辅助治疗可使部分患者的肿瘤降期、提高R0切除率,降低局部及远处复发的风险,延长患者的生存期,现已成为LAGC治疗中的重要组成部分。随着新辅助治疗的不断发展,各类临床试验和新的治疗理念不断涌现,其治疗模式也从曾经单一的化疗,转变为新辅助放化疗、新辅助化疗联合靶向治疗、新辅助化疗联合免疫治疗等新型治疗模式。本文就LAGC的新辅助治疗进展及目前存在的争议进行综述。      

Recent updates and current issues of sentinel node navigation surgery for early gastric cancer

With the increase in the incidence of early gastric cancer (EGC), several endoscopic and laparoscopic approaches, such as endoscopic submucosal dissection and function-preserving gastrectomy, have been accepted as standard treatments. Sentinel node navigation surgery (SNNS) is an ideal surgical option for preservation of most parts of the stomach and consequent maintenance of normal gastric function to improve quality of life in patients with EGC. Although many previous studies and clinical trials have demonstrated the safety and feasibility of the sentinel node concept in gastric cancer, the clinical application of SNNS is debatable. Several issues regarding technical standardization and oncological safety need to be resolved. Recently several studies to resolve these problems are being actively performed, and SNNS might be an important surgical option in the treatment of gastric cancer in the future.     

Prognostic factors of gastric cancer tumours of less than 2 cm in diameter: rationale for limited surgery.

BACKGROUND: A recent trend in the surgical treatment of patients with early gastric cancer in Japan has been to limit surgery to an extent that ensures complete cure and improvement in the patient's quality of life. If a gastric cancer tumour can be completely eradicated by laparoscopic surgery, the patient can be cured of cancer without major operative stress. A small gastric cancer tumour of less than 2 cm in diameter is an indication for laparoscopic surgery, but little is known about what protocol of surgical treatment is appropriate for this type of tumour. PATIENTS AND METHODS: The clinicopathological features of 150 patients with gastric cancer tumour of less than 2 cm in diameter were reviewed retrospectively from hospital records between 1985 and 1995. The results of retrospective analysis of clinicopathological data of 24 patients with advanced cancer were compared with those of 126 patients with early cancer. Univariate and multivariate analyses of patients with small gastric cancer tumours were performed to evaluate the prognostic significance of clinicopathological features. RESULTS: A significant difference was seen between the gross tumour appearances in the two groups; Borrmann type-4 tumours were more common in the advanced group. Lymph-node metastasis, lymphatic vessel invasion and vascular invasion were found more frequently in the advanced cancer group than in the early cancer group. Scirrhous type was more common in the advanced cancer group. In univariate analysis, unfavourable prognostic factors included deep cancer invasion, presence of lymph-node metastasis, lymphatic invasion and vascular invasion. Using Cox's proportional hazard regression model, only nodal involvement emerged as an independent statistically significant prognostic parameter associated with long-term survival. CONCLUSION: Laparoscopic surgery should not be performed on tumours that are Borrmann type in macroscopic appearance and scirrhous-type histologically. Lymph-node metastasis is an independent prognostic factor. We recommend laparoscopic surgery involving local resection of the stomach without lymphadenectomy for small, early gastric cancer tumours that satisfy the criteria mentioned above. However, the validity of this recommendation should be tested by a prospective randomized control trial in the future.