新辅助化疗在腹腔镜手术治疗进展期胃癌中的应用

目的探讨进展期胃癌在新辅助化疗后施行腹腔镜手术治疗的有效性。方法选择2005年6月至2007年3月间经病理确诊的45例进展期胃腺癌（Ⅱ、Ⅲ、Ⅳ期M0）患者，其中15例根据本人意愿和经济承受能力先用FOLFOX7方案进行新辅助化疗后予以手术（试验组）；另外30例直接行手术治疗作为对照。比较试验组患者新辅化疗后胃癌分期的变化、两组施行腹腔镜手术情况及术后病理结果的差异。结果试验组患者均顺利完成了4个周期的化疗，2例完全缓解，10例部分缓解，3例无变化；无Ⅲ级以上的不良反应发生。试验组66．7％的患者施行了腹腔镜手术，与对照组（33．3％）比较，差异有统计学意义（X^2=4．5，P=0．030）。试验组R0切除率（80．0％）和pN0比例（60．0％）明显高于对照组（46．7％和20．0％）（P〈0．05和P〈0．01）；试验组清扫淋巴结阳性率11．0％，明显低于对照组的23．8％（P〈0．01）。两组患者手术时间和术后并发症发生率比较，差异无统计学意义（P〉0．05）。结论进展期胃癌行新辅助化疗后能明显降低肿瘤的临床分期，增加R0切除的比例，缩小肿瘤的浸润范围，减少淋巴结的转移，提高使用腹腔镜进行微创手术的机会。

Application of neoadjuvant chemotherapy in laparoscopic gastrectomy for advanced gastric cancer

Objective To explore the benefit of neoadjuvant chemotherapy in advanced gastric cancer patients treated by hparoscopy. Methods Fifteen patients with histologically proved gastric adenocarcinomas (stages Ⅱ , Ⅲ, Ⅳ M0) were treated with FOLFOX7 neoadjuvant chemotherapy followed by laparoscopy between June 2005 and March 2007 (trial group). Thirty patients were assigned to the control group with only laparoscopic treatment in the same period. The clinicopathological data were compared between two groups. Results All the patients in trial group accepted four cycles of preoperative chemotherapy and the toxicity was less than grade 3. Two of them achieved complete response, 10 achieved partial response and 3 kept stable disease. Ten patients of trial group underwent iaparoscopic-assisted radical gastrectomy. The rates of R0-resection (80.0%) and pN0 (60.0%) in trial group were significantly higher than those in control group (46.7% and 20.0%), while the rate of positive lymph node 11.0%(34/309) was significantly lower than that of control group 23.8% (142/596). The operation time and postoperative complication were similar in two groups. Conclusions Advanced gastric cancer after neoadjuvant chemotherapy can be down-regulated in the stage, increase the rate of R0-resection, diminish the infiltration extent of tumor, decrease the metastasis of lymph node, and increase the possibility of laparoscopic radical gastrectomy.