Ⅲ期胃癌治疗的探讨

The treatment of gastric carcinoma in Ⅲ stage

１９７５年至１９８９年作者共收治Ⅲ期胃窦、体部癌患者２３８例，随访９０．７％，总５年生存率为４５．４％，１０年生存率为３３．７％。扩大根治组（选择性Ｒ＿３或Ｒ＿３）术后５年和１０年生存率分别为５６．３％和４７．５％，显著高于普通根治组（Ｒ＿２）的３５．７％和２３．３％。术后辅助化疗组５年生存率和１０年生存率分别为３６．４％和１２．１％。显著高于未用化疗组（９．５％和３．６％）。化疗加中药组术后生存率（７８，１％和４５％）显著高于单用化疗组。腹腔冲洗、化疗组和腹腔化疗组的腹膜转移率分别为１８．７％和２０．６％，显著低于腹腔未治疗组（３１．９％）。作者认为Ⅲ期胃癌最佳治疗方案为切除足够的胃和淋巴结，防治腹膜和血行转移。

AbstractFrom 1975 to 1989,we treated 238 cases of gas-tric carcinoma in Ⅲ stage,90.7%of these were fol-lowed up, The total 5-year survival rate was 45.4%,10-vear survival 33.7%。The 5-vear survival rate and10-vear survival rate(56.3%and 47.5%)in the ex-tensive radical treatment group(102 cases , selectiveR_3 or R_3)was much higher than that of routine radicaltreatment group(114 cases R_2 ). The 5-year survivalrate and 10-year survival rate in the group with auxil-lary post-operational chemotherapy were much higherthan those of the group without chemotherapy. Thepost-operative survival rate in the group withchemotherapy plus Chinese medicine was much higherthan that of the group with chemotherapy alone, Theperitoneal metastatic rate of the group with peritonealflushing plus chemotherapy (18.7%and 20.6%)wasmuch longer than that of the group without peritonealflushing and/or chemotherapy (31.9%). We considerthat the best treatment of gastric carcinoma in Ⅲ stageis the sufficient removal of gastric lymph nodes for theprevention of metastasis through peritoneal and circu-latorv route.