局部进展期胃癌术后进行奥沙利铂联合替吉奥辅助化疗的安全性和有效性

目的:探究奥沙利铂联合替吉奥（SOX）方案作为局部进展期胃癌D 2根治术后辅助化疗方案的安全性和有效性。 方法:采用描述性病例系列研究方法。病例纳入标准：（1）经胃镜活检或手术标本病理证实为胃腺癌;（2）接受D 2根治手术,且术后接受SOX方案辅助化疗。排除标准：（1）术后病理分期为T...     

Is There a Role for Palliative Gastrectomy in Patients with Stage IV Gastric Cancer?

Patients with metastatic gastric cancer are currently not considered operative candidates and are most often offered systemic therapy. Palliative resection of the primary tumor has been considered irrelevant to the outcome and has been recommended only for palliation of symptoms. We have examined the role of palliative gastrectomy and its impact on survival in patients with stage IV gastric cancer at initial diagnosis between 1990 and 2000. A total of 105 patients with stage IV disease were identified during this period; 81 of them (77.1%) had no resection, and 24 (22.9%) underwent palliative gastric resection. Mean survival in those without resection who received chemotherapy (with or without radiation) treatment was 5.9 months (95% confidence interval 4.2–7.6). For those with resection and adjuvant therapy, mean survival time was 16.3 months (95% confidence interval 4.3–28.8 months). Kaplan-Meier survival analysis showed significantly better survival in those with resection and adjuvant therapy (log-rank test, P = 0.01). Mortality and morbidity rates associated with palliative resection were 8.7% and 33.3%, respectively, which did not differ statistically from the 3.7% and 25.3% in patients who underwent curative gastrectomy during same period of time. However, the length of hospitalization (22 versus 16 days) was significantly higher compared with those without stage IV disease. These data suggest that palliative resection combined with adjuvant therapy may improve survival in a selected group of patients with stage IV gastric cancer. Palliative gastrectomy plus systemic therapy should be compared with systemic therapy alone in a randomized trial.     

老年病人行胃癌根治术后复发危险因素分析

目的 比较老年病人行胃癌根治术后复发与无复发病人之间的临床病理特征差异,探讨老年胃癌病人术后复发的危险因素并构建预测模型。方法 回顾性分析2010年1月至2014年12月福建医科大学附属协和医院胃外科收治并施行手术的727例老年胃癌病人资料,分为复发组（214例,29.4%）与无复发组（513例,70.6%）。进一步分析术后复发的影响因素,筛选并建立拟合度最优的多因素预测模型。结果 与无复发组相比,复发组病人术前CA19-9、术前癌胚抗原（CEA）、肿瘤大小、神经脉管浸润发生率以及术后病理学TNM分期均显著增高（P均＜0.001）。单因素分析显示,术前CA19-9、术前CEA、肿瘤分化程度、病理学分期、肿瘤大小、神经浸润、脉管浸润,以及术后辅助化疗与术后复发相关;多因素分析显示,术前CA19-9、病理T分期、N分期和术后辅助化疗为独立影响因素。进一步建立列线图预测模型结果显示,该模型具有良好的预测效能,C指数为0.781（0.761-0.801）。结论 术前CA19-9和肿瘤病理学分期是老年胃癌病人根治术后复发的独立危险因素,而术后辅助化疗是其独立保护因素。建立列线图预测模型能有效预测其术后复发,可能有助于临床随访和决策。     

Borrmann Type IV: An Independent Prognostic Factor for Survival in Gastric Cancer

Background  Borrmann type IV gastric cancer has a poorer prognosis than other gastric carcinomas. This study compared the clinicopathological features of Borrmann type IV gastric cancer with those of other types of cancer and examined the significance of a Borrmann type IV carcinoma as a prognostic factor after gastrectomy. Methods  The clinicopathological features, tumor–node–metastasis (TNM) stage, and survival rates of 4,191 advanced gastric cancer patients, who had undergone a gastrectomy at the Samsung Medical Center between 1995 and 2005, were reviewed. Results  Borrmann type IV gastric cancer was found to be associated with more advanced and unfavorable clinicopathological features at diagnosis than the other cancers. The 5-year survival rate of the patients with Borrmann type IV cancer was 27.6%. In contrast, the 5-year survival rate of patients with the other types of cancer was 61.2%. The 5-year survival rate for each stage of Borrmann type IV gastric cancer and the other type gastric cancer was 61.0% and 88.8% for stage Ib (P < 0.001), 49.8% and 76.1% for stage II (P < 0.001), 36.4% and 55.1% for stage IIIa (P < 0.001), 15.2% and 38.5% for stage IIIb (P = 0.001), and 10.2% and 20.1% for stage IV (P = 0.008), respectively. Multivariate analyses revealed a Borrmann type IV carcinoma, the surgical extent, curability, tumor stage, including T, N, and M status, and adjuvant therapy to be independent prognostic factors for survival. Conclusion  A Borrmann type IV carcinoma has unique clinicopathological features compared with other types of gastric carcinomas and is an important independent prognostic factor.     

腹腔镜胃癌D2根治术联合腹腔内热灌注化疗治疗胃癌的疗效研究

目的:探讨腹腔镜下胃癌D2淋巴结根治术联合术后腹腔内热灌注化疗治疗胃癌的临床疗效。方法:选取2010年1月至2013年9月收治的120例胃癌患者作为研究対象,采用前瞻性研究方法随机分为观察组与对照组,观察组行腹腔镜胃癌D2根治术联合术后腹腔内热灌注化疗、术后化疗;对照组行腹腔镜胃癌D2根治术联合术后化疗,观察两组术后并发症、复发率、生存率。结果:观察组术后并发症发生率为26.67%,对照组为25%,两组差异无统计学意义。随访1年、2年,两组复发率、生存率差异无统计学意义。随访3年,观察组复发率为30%,生存率为81.67%;对照组复发率为50%,生存率为58.33%,差异均有统计学意义。结论:腹腔镜胃癌D2根治术联合术后腹腔内热灌注化疗安全、有效不增加术后并发症发生率,且可提高生存率,降低复发率,值得临床推广应用。     

Chemotherapy and surgery for locally advanced cancer of the cardia and fundus: phase II study with methotrexate and 5-fluorouracil

Locally advanced cancer of the cardia and fundus might be cured by surgical resection. Poor results after surgery in stage IIIB and stage IV disease prompted a study of neoadjuvant chemotherapy. Treatment included four cycles of high doses of methotrexate (1.5 g/m2) and high doses of 5-fluorouracil (1.5 g/m2) followed by surgery in those patients with lesions then found to be resectable. Twenty patients with tumours staged as IIIB or IV were entered; 17 patients completed the four courses of chemotherapy and 14 underwent re-exploration. Eight patients achieved tumour reduction enabling resection. Five patients underwent total gastrectomy with distal pancreatectomy and splenectomy en bloc and three patients had an oesophagogastrectomy. There were no treatment-related deaths and toxicity was tolerable. Two patients were alive 54 and 41 months after chemotherapy with no evidence of disease. Locoregional recurrence developed in five patients and metastatic disease in one. Their median survival was 22 months.     

Adjuvant chemotherapy for locally advanced urothelial carcinoma: an overview of the USC experience

Objectives  To describe the tolerability of two chemotherapy regimens, gemcitabine and cisplatin (GC) and methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) for adjuvant treatment of patients with locally advanced urothelial cancer after radical cystectomy. Methods  The USC Department of Urology bladder cancer database was searched for subjects who received adjuvant chemotherapy following cystectomy for transitional cell carcinoma with extravesical and/or lymph node involvement, yielding 187 cases. Clinical details regarding toxicity, number of cycles administered, and cancer outcome were analyzed. Results  The majority of subjects had lymph node involvement (70%). Sixty-eight percent of subjects received MVAC and 32% received GC, the latter regimen was predominant after 2000. Fifty-six percent of subjects received all four planned cycles (51% GC and 58% MVAC). With a median follow-up of 11.2 years (range 1.9–19.6), 96 patients (51%) have suffered a relapse, with no significant difference between chemotherapy regimens. Median time to recurrence for the population was 3.7 years and median overall survival is 4.6 years (3.0–9.3). The median time from recurrence to death was 6.7 months and was not significantly different between MVAC and GC. Conclusions  Both MVAC and GC are tolerated after cystectomy for advanced urothelial carcinoma. A significant proportion of high-risk patients survive, free of disease, beyond 10 years. At recurrence, patients previously treated with adjuvant chemotherapy have a survival that appears much shorter than patients who develop metastases in the absence of this exposure, suggesting resistance to salvage chemotherapy.     

早期胃癌患者腹腔镜胃癌根治术后复发相关因素分析

目的分析早期胃癌患者腹腔镜胃癌根治术后复发的相关临床因素及预后。 方法回顾性分析2012年3月至2016年3月收治的胃癌患者100例,根据手术方法的不同分组,分为开腹组(50例,开放式胃癌切除术治疗)、腹腔镜组(50例,腹腔镜胃癌根治术治疗),运用SPSS 26.0进行统计学分析,两组术后1年、2年、3年复发率采用以χ²检验;手术情况、VAS及GLQI评分等计量资料以( ±s)表示,独立t检验,Logistic分析术后复发危险因素,P<0.05差异有统计学意义。 结果腹腔镜组手术时间、切口长度、住院时间明显比开腹组短,腹腔镜组术中出血量、VAS评分明显比开腹组低,腹腔镜组GLQI评分明显比开腹组高;1年、2年、3年复发率比较,腹腔镜组(8.0%、14.0%、26.0%)与开腹组(12.0%、20.0%、34.0%)比较两组差异无统计学意义(P>0.05)。年龄、肿瘤直径、术后是否化疗、TNM分期是影响腹腔镜胃癌根治术术后复发独立危险因素,P<0.05。 结论腹腔镜胃癌根治术在胃癌治疗中可显著缩短患者治疗时间,减轻患者疼痛感。年龄、肿瘤直径、术后是否化疗、TNM分期是导致胃癌患者术后复发的独立危险因素,应当引起临床重视。     

Follow-Up After Gastrectomy for Cancer: An Appraisal of the Italian Research Group for Gastric Cancer

Background

The Italian Research Group for Gastric Cancer supports the practice of follow-up after radical surgery for gastric cancer.

Methods

This multicenter, retrospective study (1998–2009) included patients with T1-4N0-3M0 gastric cancer who had undergone D2 gastrectomy and lymphadenectomy, with at least 15 lymph nodes examined, and who had developed recurrent disease. Timing and site of recurrence were correlated to the actual scheduled follow-up timing and modalities.

Results

From eight centers, 814 patients with recurrent cancer and over 1,754 (46.4 %) patients undergoing gastrectomy were investigated (median follow-up 31 months). The most frequent sites of recurrence were local/regional lymph nodes (35.4 %), liver (24.3 %), peritoneum (30.3 %), lung (10.4 %) and intraluminal (7.5 %). Ninety-four percent of the recurrences were diagnosed within 2 years and 98 % within 3 years. Thoracoabdominal computed tomography (CT) scan and (18)F-fluoro-2-deoxy-d-glucose positron emission tomography (18-FDG-PET) detected more than 90 % of recurrences, abdominal ultrasound detected 70 % and tumor markers detected 40 %, while <10 % were identified by physical examination, chest X-ray, and upper gastrointestinal endoscopy. Twenty-six percent of patients with recurrence were treated, but only 3.2 % were treated with potentially radical intent.

Conclusion

Oncological follow-up after radical surgery for gastric cancer should be focused in the first 3 years, and based mainly on thoracoabdominal CT scan and 18-FDG-PET.     

Estrogen Replacement Therapy After Breast Cancer: A 12-Year Follow-Up

Background: In the United States, estrogen replacement therapy ERT is discouraged in breast cancer survivors because of concerns that hormones may reactivate the disease. Because ERT can improve quality of life and decrease morbidity from osteoporosis and cardiovascular disease, however, this policy is increasingly being challenged.Methods: From February to August 1995, 607 breast cancer survivors were interviewed concerning ERT usage. Sixty-four patients indicated they received some form of ERT after their breast cancer diagnosis. Medical records for these patients were analyzed for disease stage, surgical treatment, adjuvant treatment, estrogen and progesterone receptor status, date of initiation of ERT, type of ERT, recurrence, and final outcome. Patients receiving ERT were followed prospectively.Results: Eight patients were excluded because they had used only vaginal cream ERT. The remaining 56 received ERT as conjugated estrogens, an estradiol patch, estropipate, or birth control pills. The median follow-up from diagnosis was 12.8 years range, 4.7–38.9 years. The median time on ERT since diagnosis was 6.4 years range, 1.0–20.9 years; 38% of the patients initiated ERT within 2 years of diagnosis. Estrogen receptors were positive in 28 74% of the 38 cases with available information. Pathological disease stage at time of diagnosis and treatment was 0 in 15 cases 27%, I in 27 48%, and II in 14 25%. Twenty-six patients 47% received adjuvant chemotherapy or hormonal therapy. One local recurrence and one contralateral breast cancer occurred during the follow-up period 13.5 and 9.6 years, respectively, with no regional or distant recurrences, for a 15-year actuarial disease-free survival rate of 92.5%. There were no breast cancer deaths.Conclusions: Use of ERT in a cohort of breast cancer survivors with tumors of generally good prognosis was not associated with increased breast cancer events compared with non-ERT users, even over a long follow-up period.Presented at the 54th Annual Meeting of the Society of Surgical Oncology, Washington, DC, March 15–18, 2001.     

A case with synchronous multiple liver metastases from gastric carcinoma: postoperative long-term disease-free survival

Purpose  We herein report a case with synchronous multiple liver metastases from gastric carcinoma surviving disease-free for more than 10 years after hepatic resection. Methods  A 64-year-old male admitted to our hospital because of constitutional wariness. Preoperative diagnosis was type 1 gastric cancer at the lower third of the stomach and multiple metastases of both hepatic lobes. After we performed distal gastrectomy with regional lymphadenectomy and wedge hepatic resection for eight metastatic liver tumors, he received 5-fluoropyrimidine and platinum-based adjuvant chemotherapy during the early postoperative period. Results  The pathologic examination revealed moderately differentiated gastric adenocarcinoma with regional lymph node metastasis and multiple liver metastases. The postoperative course was uneventful and the patient is doing well without disease recurrence after more than 10 years following surgery. Conclusion  To the best of our knowledge, this patient is the longest disease-free survivor after liver resection for synchronous multiple liver metastases from advanced gastric cancer. In this modern era of developing liver surgery and adjuvant chemotherapy, combination therapy of aggressive surgery and early postoperative adjuvant chemotherapy for advanced gastric cancer with liver metastasis may allow long-term survival in selected patients.     

间接比较亚裔人群Ⅱ～Ⅲ期胃癌D2根治术后的辅助化疗方案

目的间接比较亚裔人群Ⅱ-Ⅲ期胃癌D2根治术后不同辅助化疗方案的疗效。方法通过数据库电子检索以及手工检索相关文献,选择Ⅱ-Ⅲ期亚裔胃癌D2根治术后辅助化疗与单纯手术治疗比较的前瞻性随机对照临床试验（RCT）。选择总生存率和无病生存率为研究终点指标,通过Bucher校正间接比较法比较不同辅助化疗方案的疗效。结果2项研究纳入分析,1项研究涉及替吉奥（S．1）辅助化疗与单纯手术比较,1项研究涉及XELOX方案（奥沙利铂加卡培他滨）辅助化疗与单纯手术比较。间接比较结果显示,S-1与XELOX方案对总生存率影响的差异无统计学意义（HR=0．94,95％CI：0．62～1．44,P=0．79）。S-1较XELOX方案复发风险略有增加．但差异无统计学意义（HR=1．11,95％CI：0．80～1．53,P=0．54）。结论亚裔人群胃癌D2根治术后,S-1单药与XELOX方案辅助化疗疗效近似。     

胃癌根治术后早期复发转移的相关因素分析

目的 探讨胃癌术后早期复发转移的相关危险因素.方法 回顾性分析2001年1月至2004年12月间收治的141例行胃癌根治术后复发转移患者的临床病理资料,探讨胃癌术后早期复发(≤1年,82例)的临床病理因素及其预后.结果 早期复发组与对照组(1年后复发转移,59例)的1、3年存活率分别为36.6%、2.4%和100%、45.8%,两组存活率差异有统计学意义(P＜0.05);早期复发组、对照组复发转移后中位生存时间分别为3、5个月,两组差异有统计学意义(P＜0.05).单因素分析显示年龄、肿瘤大体分型、肿瘤部位、浸润深度、淋巴结转移、TNM分期、淋巴结转移率、术式、腹腔热灌注化疗与胃癌根治术后早期复发转移的发生相关(P＜0.05);多因素分析发现淋巴结转移、淋巴结转移率及腹腔热灌注化疗是影响胃癌根治术后早期复发转移发生的独立因素(P＜0.05).结论 早期复发转移病例生存率低、复发转移术后生存时间短.淋巴结转移、淋巴结转移率及腹腔热灌注化疗是影响胃癌根治术后早期复发转移的独立危险因素.     

腹腔镜胃癌根治术

目的 评价腹腔镜胃癌根治术(D2)的可行性、安全性以及术后近期疗效. 方法回顾性分析2005年5月至2006年8月间15例行腹腔镜胃癌根治术患者的临床资料,包括手术时间、术中出血量、术后胃肠道功能恢复时间、术后并发症、术后病理及随访结果.结果 本组15例患者手术全部成功,术中无1例中转开腹.其中5例行完全腹腔镜远端胃切除术,5例行腹腔镜辅助远端胃切除术,4例行腹腔镜全胃切除术,1例行腹腔镜近端胃切除术.手术时间平均为(280±42)min,术中出血量平均为(274±136)ml,术后胃肠道功能恢复时间平均为(2.9±0.8)d,淋巴结清扫数平均为(28±6)枚,无并发症发生.术后随访15例患者9～36个月,无复发转移.结论 腹腔镜胃癌根治术安全可行,且具有创伤轻、恢复快等优点.     

进展期胃癌术中应用氟尿嘧啶缓释剂间质化疗的临床疗效

目的评价进展期胃癌根治术中植入5-FU缓释剂间质化疗的临床疗效和安全性。方法 102例进展期胃癌患者(术前均经胃镜和病理检查确诊)随机分为治疗组和对照组,各51例。2组均行D2根治术,治疗组在手术结束时局部植入5-FU缓释剂进行间质化疗,术后4周进行6个周期常规化疗;对照组术中不进行腹腔内干预性治疗,术后化疗方案同治疗组。结果 2组患者的腹腔引流量、白细胞水平、白蛋白水平及消化道不良反应方面的差异均无统计学意义(P>0.05);中位随访时间为28个月,治疗组肿瘤局部复发率低于对照组(16.3%比39.1%,P<0.05),治疗组术后3年的总生存率高于对照组(85.8%比67.3%,P<0.05)。结论进展期胃癌行D2根治术时植入5-FU缓释剂进行间质化疗无明显不良反应,能减少局部复发率,提高患者生存率,是治疗胃癌行之有效的方法。     

Postoperative UFT Adjuvant and the Risk Factors for Recurrence in Renal Cell Carcinoma: A Long-Term Follow-Up Study

Background Radical nephrectomy is the standard therapy for low-stage renal cell carcinoma. However, recurrence sometimes develops even in patients who are considered to have undergone a curative resection of the primary tumor. The purpose of this study was to evaluate the usefulness of UFT (a 1: 4 mixture of tegafur and uracil) adjuvant and the risk factors for recurrence in renal cell carcinoma.
Methods A prospective randomized trial was conducted to compare the use of long-term oral UFT adjuvant with nonadjuvant therapy after a radical nephrectomy for Robson stage I or II renal cell carcinoma. A multivariate analysis was also performed to estimate the risk factors for recurrence.
Results A total of 71 patients were entered into this study, and 66 were evaluable (33 for each group). There was no significant difference in patient characteristics between the 2 groups. The nonrecurrence rate at 5 years after a radical nephrectomy was 80.5% and 77.1% in the UFT adjuvant group and the nonadjuvant group, respectively, with a median follow-up of 112.9 months; the difference was not significant. The toxicity of UFT was generally mild and tolerable. The tumor grade was found to be an important factor influencing recurrence.
Conclusion UFT cannot be universally recommended as an adjuvant therapy for radical nephrectomy in all patients with low-stage renal cell carcinoma.     

Re-study of Gastric Cancer: Analysis of Outcome

Cancer of the stomach (CaS) is a dreaded disease. Fortunately, there is a decreasing incidence, except in the East. The authors did a re-study of CaS, a widely investigated but unresolved gastrointestinal malignancy. The clinicopathologic features were evaluated to identify and measure the prognostic factors that would help the surgeon decide optimal therapy. Among 383 admitted for CaS at the East Avenue Medical Center, Quezon City, Philippines between January 1987 and December 1996, 149 underwent radical resection with curative intent. (As historical control, the experience in 136 cases was reviewed during the immediately preceding 5-year period [1982–1986] when extended lymphadenectomy was not the standard policy.) For staging, the TNM system (tumor-node-metastasis) was used; to describe anatomy and surgery of stomach lymphatics, the "Japanese Rules," as modified, were adapted. Curative radical gastrectomy would include removal of the diseased stomach and regional lymphatics as defined by frozen section, including subtotal (or total) gastrectomy and "extended" D2 (with no. 12) node dissection. The clinicopathologic factors were statistically analyzed, using the accepted methods: Kaplan-Meier for survival, univariate analysis, and multivariate analysis for independent predictors. Of the 12 risk factors assessed by univariate analysis, the following were identified by multivariate analysis as independent prognosticators of survival: (1) wall penetration; (2) node invasion; (3) TNM stage; (4) resection margin; and (5) tumor size. After curative resection, the operative mortality was 5.3% and the complications, 19.4%. The 5-year survival was 60.4%, and recurrence, 15.4%. The results have shown that the pathology-related factors, (1) wall penetration; (2) node invasion; and (3) resection margin, are independent prognosticators of survival, remarkably affecting outcome. In conclusion, the study supports radical gastrectomy with extended D2 lymphadenectomy for CaS as safe and effective. Survival and recurrence are a function of pathology and adequate resection; operative mortality is defined by the patient’s condition.     

侵袭性胸腺瘤手术治疗预后因素的随访

目的 观察侵袭性胸腺瘤的手术治疗效果,并分析影响患者预后的相关因素.方法 回顾性分析2000年1月至2009年12月接受手术治疗的59例侵袭性胸腺瘤患者的临床及随访资料.患者为连续病例,男性34例,女性25例;年龄18～72岁,平均49岁.根治性手术44例,姑息切除或活检15例.Masaoka分期:Ⅱ期18例,Ⅲ期30例,Ⅳ期11例;Ⅱ期患者术后未接受辅助放疗或化疗,Ⅲ、Ⅳ期患者术后接受辅助放疗和(或)化疗26例,未接受辅助放疗或化疗15例.分析手术方式、Masaoka分期、辅助放疗和(或)化疗与患者预后的关系.结果 本组59例患者随访时间1～111个月,平均54个月;失访3例,失访率6.1%.全组局部复发或全身转移19例,死亡14例,3年、5年生存率分别为86.8%、70.8%.单因素分析显示接受完全性切除手术、Masaoka分期较早及术后接受辅助放疗和(或)化疗的患者有较高的生存率(P＜0.05).多因素分析显示是否完全性切除、术后接受辅助放疗和(或)化疗是影响患者预后的独立因素(P＜0.05).结论 Masaoka分期与侵袭性胸腺瘤患者预后相关;完全性切除手术及术后辅助放化疗可显著提高患者生存率;部分复发患者再次手术后亦可获得长期生存.     

A cohort study on second malignancies in gastrectomized patients with gastric cancer II. Second maliganacies in the gastric remnant

In a retrospective cohort study, a total of 22 (0.22 per cent) carcinomas of the gastric remnant were clinically observed, as second malignancies, in 7,672 patients during the average of a 9.4-year follow-up period. All had undergone distal subtotal gastrectomy for gastric cancer from 1960–1975 in seven different institutions. Of 22 carcinomas of the gastric remnant, 5 were at the anastomotic site, 14 distant from the anastomosis; the location was unknown in three. All five carcinomas of the anastomotic site occurred after Billroth II operation. Time intervals between the first operation and the occurrence of second cancer varied from two to 21 years. With regard to the administration of adjuvant chemotherapeutic agents such as mitomycin-C (MMC), 5-fluorouracil (5FU) or its derivative Tegafur, no significant differences in the rate of second malignancies were obtained between the chemotherapy and non-chemotherapy groups. The occurrence rate of cancer of the gastric remnant between Billroth I and Billroth II groups showed no statistically significant difference, although it did tend to be slightly higher in the latter.     

手助腹腔镜行胃癌D2 根治术的手术安全与技术路径探讨

目的:探索手助方式在腹腔镜胃癌D2根治术中应用的可行性和技术路径。方法:回顾性分析自2010年12月—2011年5月的胃癌患者30例的临床资料,采用自行设计的手术路径,实施手助腹腔镜胃癌D2根治术治疗。结果:成功施行手辅助腹腔镜胃癌D2根治术29例。其中根治性全胃切除术15例,根治性近端胃切除术3例,根治性远端胃切除术11例。全程手术时间150～210 min(平均177 min);手术切口长度6～7 cm(平均6.86 cm);术中出血80～600 mL(平均228 mL)。手术后病理检出淋巴结数11～35枚(平均16.79枚)。29例均没有发现手术切缘癌残留。TNM分期:I期1例,II期2例,III A期8例,III B期6例,IV期12例。术后并发胃无力症1例。全组因术中出血中转开腹手术1例。结论:笔者自行设计的手辅助腹腔镜技术路径能够满足胃癌D2根治术的手术操作规范需求,安全、可行,并有可能成为一种新的胃癌手术模式。