联合脏器切除治疗进展期胃癌38例分析

 进展期胃癌确诊时已侵犯邻近或远隔脏器,是否联合切除受累脏器,直接影响到手术的疗效。由于现代手术技术的进步,麻醉、监护、营养支持及抗生素的运用不断改进和完善,复杂手术的并发症发生率和死亡率都有明显的下降。我院自1994年1 月～1999年12 月共行联合脏器切除治疗胃癌38 例,占同期胃癌手术总数的6.1% (38/232) 。现分析如下:     

联合脏器切除治疗中晚期胃癌

胃癌是一种以局部浸润和淋巴结转移腹腔种植为主的恶性肿瘤,随着对胃癌生物学特性认识的提高,胃癌的手术治疗态度更为积极［１］,完全根治性切除ＣＲ）是提高胃癌生存率的关键。自１９８０年６月—１９９２年６月我们行联合脏器切除６６例胃癌,现将资料总结如下。１临...     

联合脏器切除治疗进展期癌28例临床分析

回顾性分析了1995－1998年联合脏器切除术28例进展期胃癌患者的临床资料。18例根治性切除，10例姑息性切除。联合横结肠及系膜切除6例，联合脾切除10例，联合胰体尾脾切除5例，联合胰体尾脾肝左外叶切除2例，联合左肝部分切除2例，联合胰体尾脾横结肠3例。生存超过5年 的4例，超过3年的7例，超过1年的14例。     

联合脏器切除根治T4期胃癌40例

由于胃癌的生物学特性和临床表现缺乏特异性,外科手术是治疗胃癌的主要手段,对侵犯邻近脏器的T4期胃癌行联合脏器切除根治具有积极意义.我院从1997年～2004年共收治40例,现报告如下.     

联合脏器切除在晚期胃癌外科治疗中的应用探讨（附18例临床报告）

晚期胃癌的手术治疗,过去多以姑息性手未为主,联合脏器切除的应用,目前尚有不同意见。本文报导18例晚期病例行联合脏器切除术,无手术死亡,无严重并发症,生存期延长,为进一步综合治疗创造了条件。指出对晚期病例应分为有根治可能和无根治可能两组,有根治可能者,只要全身情况可耐受较大手术,应积极行根治性联合脏器切除术。并阐述了根据胃部癌肿部位及病变范围,直接侵犯临近器官及淋巴转移情况等几个方面选择具体的手术切除方式,可行胃部分或全胃联合脾胰体尾、横结肠及其系膜、肝不规则切除术等,根据淋巴结转移情况选择R_2、R_2~ 或R_3手术;强调远侧胃切除后多采用Roux-y或毕Ⅰ式吻合,全胃切除后行食管一空肠“P”型加空肠输出入“Y”型吻合术。强调围手术期处理的重要性,术前应提高病人对手术的耐受性,术后常规行全胃肠外营养支持,防治胰腺切除后并发症。术前,术中,术后化疗宜根据病人具体情况进行。     

32例进展期胃癌联合脏器切除临床分析

目的：探讨进展期胃癌手术治疗中联合脏器切除的可行性。方法：回顾性分析我科自1998年-2000年施行多脏器联合切除治疗的中、晚期胃癌患者的临床资料，其中肉眼下根治性手术切除23例，姑息性切除9例。对手术治疗结果进行分析。结果：术后无严重并发症，无手术死亡的病例。除1例失访外，其余31例经门诊和电话随访。随访5年后，其1、3、5年生存率分别为53．13％（17／32）、28．13％（9／32）、21．88％（7／32）。结论：联合脏器切除用于进展期胃癌的治疗是可行的，能延长患者生存时间；加强围手术期管理，不会明显增加手术并发症。因此，只要情况许可，联合脏器切除仍应作为进展期胃癌局部浸润转移首选的治疗方式。     

联合脏器切除治疗晚期贲门癌

目的　通过对 16例晚期贲门癌的临床追踪分析 ,以探讨其手术指征和疗效。方法　 1988年 3月至 1996年 6月对 16例贲门癌由于与其它脏器粘连浸润而行联合脏器切除 ,其中贲门癌合并肝左外叶切除 4例 ,合并脾切除 2例 ,合并胰体尾、脾切除 10例。结果　全组无手术死亡 ,无吻合口瘘 ,术后并发症发生率为 18.8% ( 3 / 16) ,均治愈 ,根治性切除 1、3、5年生存率分别为 5 0 %、2 5 %、12 .5 % ,姑息性切除均在半年内死亡。结论　贲门癌粘连浸润其它脏器应争取根治性切除 ,不能根治性切除者 ,应尽量避免进行复合脏器切除     

32例进展期胃癌联合脏器切除临床分析

目的:探讨进展期胃癌手术治疗中联合脏器切除的可行性.方法:回顾性分析我科自1998年～2000年施行多脏器联合切除治疗的中、晚期胃癌患者的临床资料,其中肉眼下根治性手术切除23例,姑息性切除9例.对手术治疗结果进行分析.结果:术后无严重并发症,无手术死亡的病例.除1例失访外,其余31例经门诊和电话随访.随访5年后,其1、3、5年生存率分别为53.13%(17/32)、28.13%(9/32)、21.88%(7/32).结论:联合脏器切除用于进展期胃癌的治疗是可行的,能延长患者生存时间;加强围手术期管理,不会明显增加手术并发症.因此,只要情况许可,联合脏器切除仍应作为进展期胃癌局部浸润转移首选的治疗方式.     

多脏器联合切除治疗中、晚期胃癌的疗效分析

背景与目的:目前,我中心所收治胃癌病例中26.05%的患者探查时发现已有不同程度的周围脏器侵犯。针对该部分中、晚期患者的手术治疗问题,长期以来存有争议。本研究旨在对该类病例手术治疗中联合脏器切除的可行性进行探讨。方法:回顾性分析我中心自1985年～1995年施行多脏器联合切除术治疗的44例中、晚期胃癌患者的临床资料,其中行根治性手术切除34例,姑息性切除10例。对不同性质的手术治疗结果进行分析。结果:联合脏器切除根治性胃癌手术治疗组中位生存期为588天(平均1676天),姑息性切除治疗组中位生存期344天(平均1045天)(P>0.05),无严重术后并发症,无因扩大手术导致死亡的病例。结论:联合脏器切除用于中、晚期胃癌的根治性治疗是可行的,即便是姑息性切除仍可收到较好的疗效。因此,只要情况许可,根治性的手术切除仍应作为其首选的治疗方式。     

全胃加联合脏器切除治疗中晚期胃癌（附120例报告）

全胃加联合脏器切除治疗中晚期胃癌（附１２０例报告）浙江省湖州市第二医院（３１３０００）沈梓云，吴平，张贵阳，王洪近年来，随着对胃癌生物学特性的研究，胃癌的手术治疗倾向更积极的态度［１］。本院１９７６年１月～１９９０年１２月对邻近器官受侵的中晚期胃癌行...     

磨积散联合化疗治疗中晚期胃癌临床观察

目的：观察磨积散对中晚期胃癌患者的临床疗效。方法：采用双盲、随机、平行对照的方法将60例患者随机分成治疗组和对照组，治疗组化疗同时给予磨积散口服，观察两组的临床疗效。结果：磨积散对中晚期胃癌患者的总有效率为83．33％，对照组总有效率67．67％，二者无显著性差异；Kps评分两组的总有效率分别为93．33％、56．67％，有显著性差异；治疗组中医临床证候疗效显著高于对照组；对照组骨髓抑制现象较为显著，明显高于治疗组。结论：磨积散联合化疗治疗中晚期胃癌安全有效。     

培美曲塞联合卡培他滨治疗晚期乳腺癌的疗效观察

目的观察培美曲塞联合卡培他滨治疗晚期乳腺癌的临床疗效和不良反应。方法培美曲塞500mg/m2,第1天;卡培他滨2500mg/（m2·d）,分2次口服,第1～14天,21d为1个周期。所有病例均接受至少2个周期的化疗。结果 27例患者入组均可评价疗效,CR率3.7%（1/27）,PR率22.2%（6/27）,SD率37.0%（10/27）,PD率37.0%（10/27）,有效率25.9%（7/27）,临床获益率55.6%（15/27）。中位随访期10个月,中位TTP7个月,中位OS9.5个月,1年生存率为66.7%。主要不良反应为骨髓毒性及手足综合征,Ⅲ度及Ⅳ度白细胞减少为18.5%（5/27）。手足综合征发生率77.7%（21/27）,其中,Ⅲ度及Ⅳ度手足综合征发生率为7.4%（2/27）。结论培美曲塞联合卡培他滨方案治疗蒽环类和紫杉类耐药转移性乳腺癌有较好的疗效,患者耐受性好,值得临床进一步研究。     

Clinical efficacy of S-1 combined with cisplatin for advanced gastric cancer

Several chemotherapy regimens used against advanced gastric cancer have been studied extensively over the decades in an attempt to further improve the prognosis of patients. To date, no standard chemotherapeutic regimens have been established worldwide. S-1 (TS-1^®), a combination of ftorafur and two modulators, gimestat (CDHP) and oxonic acid, in a molar ratio of 1?:?0.4?:?1, has been widely used in Japan for the treatment of advanced gastric cancer, and much attention has been paid to attempts to increase its antitumor effect by combining it with other chemotherapeutic drugs. We treated 12 patients with advanced gastric cancer with 80?mg/m² of S-1 for 21 days and 60?mg/m² of cisplatin (CDDP) on day 8 every 5 weeks. The treatment was continued until disease progression, unacceptable toxicity, or the patient's refusal. Eight out of 12 evaluable patients achieved a partial response (PR), with a response rate of 66.7%. The incidence of grade 3 or 4 adverse effects, including myelosuppression and gastrointestinal toxicities, was 16.6%. None of the patients treated with this regimen died of adverse effects and none required hospitalization for the toxicity. We conclude that the combination of S-1 and CDDP seems to have a high therapeutic index, enhancing the antitumor effect of S-1 while maintaining modest adverse effects, thus suggesting the possible use of this combination based at the outpatient clinic (apart from a short stay in hospital during the infusion of CDDP with hydration). Further study with a large number of patients may be needed to confirm the combination of S-1 and CDDP to be an appropriate first-line chemotherapy for gastric cancer.     

Noncurative resection for advanced gastric cancer.

Between 1965 and 1985, 489 patients with advanced gastric cancer who were treated with gastric resection and in whom tumor cells remained after the operation were defined as cases of a "noncurative resection." The clinicopathological features and prognosis of these patients were examined and two groups were prepared: locally advanced cancer and cancer with a distant metastasis. In locally advanced cancer cases, tumor cells remained in the neighboring organs, lymph nodes, and/or resected margins; in those with distant metastasis, peritoneal dissemination and/or liver metastasis were present regardless of whether or not the metastasis was removed, with or without locally noncurative factors. Serosal invasion was prominent and high rates of lymph node metastasis and lymphatic involvement were evident in both groups. The survival rate for patients with locally advanced gastric cancer was better than that of patients with distant metastasis (P < 0.01). Survival time in patients with locally advanced cancer can be lengthened by resecting all of the primary tumor and as much of the metastatic lesions as possible, even if the surgical management is "noncurative." Aggressive postoperative chemotherapy for patients with distant metastasis from a gastric cancer is to be recommended.     

岩舒注射液配合化疗治疗晚期胃癌的临床疗效观察

目的观察岩舒注射液配合化疗（5-Fu/CF/DDP方案）对晚期胃癌的临床疗效。方法 96例患者随机分为治疗组和对照组,治疗组给予岩舒注射液配合5-Fu/CF/DDP方案化疗,对照组单纯给予5-Fu/CF/DDP方案化疗。结果治疗组有效率为43.8%,对照组为41.7%,两组比较差异无显著性（P〉0.05）;但治疗组稳定率为81.3%,对照组为70.8%,两组比较差异有显著性（P〈0.05）。并且治疗组生活质量改善、症状改善、体重增加均优于对照组（P〈0.05）。同时治疗组CD3、CD4、CD4/CD8水平的提高亦明显高于对照组（P〈0.05）。治疗组的主要毒副反应明显减轻,尤其在消化道反应和骨髓抑制方面,两组比较差异均有显著性（P〈0.05）。结论岩舒注射液联合5-Fu/CF/DDP方案化疗具有提高免疫功能和一定的减毒增效作用,可进一步改善症状、延缓疾病进展、提高生存质量。     

Cytoreductive surgery combined with organ resection for advanced ovarian carcinoma

Background: The survival effects of combined organ resection in cytoreductive surgery for advanced ovarian carcinoma with regard to the site and the number of organs involved have not yet been clarified. Methods: Data obtained from 143 patients with stage III/IV ovarian carcinoma were used for analysis. Combined organ resection (COR) was employed in 21 patients in whom optimal cytoreduction (defined as a residuum ≦2 cm in diameter) was expected to be achieved by the procedure. Results: The tumors were optimally cytoreduced in 98 (68.5%) of 143 patients, either in primary surgery (n = 53) or in interval cytoreductive surgery (n = 45). The overall survival of patients with optimal cytoreduction was significantly higher than that of patients with nonoptimal cytoreduction (P < 0.01). There was no significant difference between the survival of patients in the optimal primary cytoreduction group and that of patients in the optimal interval cytoreduction group. The survival of stage III patients who underwent optimal surgery with COR was comparable to that of stage III patients who underwent optimal surgery without COR and was better than that of stage III patients who underwent nonoptimal surgery (P < 0.01). However, no effect of COR on the survival of stage IV patients was found. In the group of stage III patients who underwent optimal surgery with COR, the survival time tended to be shorter in patients who had upper abdominal organ resections (P = 0.059), and it was significantly shorter in patients who underwent resections of two or more organs (P = 0.0299). There was no operative mortality in any of the patients who underwent COR. Conclusion: Although COR has therapeutic significance for stage III ovarian carcinoma, the survival periods of patients with stage III ovarian carcinoma who have undergone additional upper abdominal organ resections, or two or more organ resections, may be shorter than the survival periods of patients with stage III ovarian carcinoma who have undergone resection of a single non-upper-abdominal organ. Received: July 4, 2002 / Accepted: January 20, 2003 Correspondence to:N. Sakuragi     

晚期胃癌姑息性切除手术的临床价值

目的探讨Ⅳ期胃癌姑息性切除手术的临床意义.方法1990年-1997年获随访的Ⅳ期胃癌35例中,18例行肿瘤姑息性切除术,17例肿瘤未切除.结果晚期胃癌手术切除组生存率明显高于未切除组(P=0.0278),其中以胃癌仅伴邻近器官浸润及或仅伴非弥漫性肝转移,或仅伴腹膜种植组手术切除后疗效最佳,二、三年生存率分别为50%、33.33%.肿瘤切除组生存质量明显好于未切除组(P＜0.005).结论晚期胃癌全身情况及局部情况允许时应争取行肿瘤切除术,可提高术后生存率及术后生命质量.     

DC-CIK联合化疗治疗晚期胃癌的近期疗效

目的 观察树突状细胞(dendritic cell,DC)与细胞因子诱导的杀伤细胞(cytokine induced killer cell,CIK)联合化疗治疗晚期胃癌的近期疗效.方法 分析68例经病理学确诊为晚期胃癌患者的临床资料,其中观察组34例,采用自体DC-CIK联合XELOX方案(卡培他滨+奥沙利铂)化疗;对照组34例,单独采用XELOX方案化疗,疗程为2周期.治疗结束后对两组的近期疗效、不良反应、免疫功能进行评价.结果 观察组客观缓解率为52.9％,对照组为41.2％,差异无统计学意义(P＞0.05);观察组疾病控制率为79.4％,高于对照组(52.9％),差异有统计学意义(P＜0.05).观察组骨髓抑制、胃肠反应、神经毒性、手足综合征不良反应发生率均低于对照组(均P＜0.05).观察组T淋巴细胞亚群CD3+、CD4+、自然杀伤细胞(natural killer cell,NK)升高,CD4+/CD8+比值上升,与对照组比较差异均有统计学意义(均P＜0.05).对照组CD3+、NK治疗后较治疗前明显下降,差异均有统计学意义(均P＜0.05).结论 DC-CIK联合XELOX方案治疗晚期胃癌可以提高近期疗效,增强患者免疫功能,减轻化疗不良反应,值得临床推广.     

胃部分切除术治疗早期胃癌的临床疗效

目的探讨胃部分切除术治疗早期胃癌的临床疗效。方法收集2008年1月至2011年1月间收治的早期胃癌患者124例,其中行胃部分切除术的62例作为观察组,行常规远端胃切除术的62例作为对照组,比较两组患者的疗效。结果观察组患者术后15、30、60 min的胃排空功能均显著优于对照组(P<0.05),术后60 min胆囊收缩功能显著优于对照组(P<0.05)。术后6个月,观察组的身体质量指数(BMI)显著高于对照组(P<0.05);观察组患者术后远期并发症显著低于对照组(P<0.05)。两组患者的3年复发率和生存率的差异无统计学意义(P>0.05)。结论胃部分切除术治疗早期胃癌可有效改善患者的胃排空和胆囊收缩功能,保留BMI水平,减少远期并发症和复发率,值得推广应用。     

紫杉醇联合CF／5-FU治疗晚期胃癌22例临床观察

目的 观察紫杉醇为主联合亚叶酸钙／5-氟尿嘧啶（5-FU）治疗晚期胃癌的疗效及不良反应。方法 化疗方案：紫杉醇（Taxol）＋亚叶酸钙（CF）／5-FU，28d为一个周期，连用2周期后评价疗效。Taxol每周疗法，60mg／m^2加入0．9％生理盐水500mL静滴，不少于3h，d1、d8、d15；CF200mg，d1-d5，5-FU 600mg／m^2，d1-5。结果 全组共完成化疗70周期，22例均可评价疗效，全组1例CR（4．6％），8例PR（36．4％），总有效率40．9％。8例SD（36．4％）；5例PD（22．7％）。毒副作用，主要为骨髓抑制，白细胞减少占81．8％，其中Ⅰ、Ⅱ级占77．3％；脱发占81．8％，均为Ⅰ、Ⅱ级；肌肉节痛占54．5％；其它还包括过敏（4．6％）、腹泻（9．1％）、肝功异常（22．8％）、心电图异常（4．6％）等。但无严重超敏反应，无治疗相关性死亡。结论 晚期胃癌病人使用以紫杉醇为主联合化疗方案具有一定的疗效，毒副反应可以耐受，在晚期胃癌缺乏有效治疗措施的情况下可作为一种较好选择。