胃癌外科治疗的研究热点

Focused problems on surgery for gastric cancer

概述胃癌外科临床研究的若干热点问题。介绍前哨淋巴结检测、微转移测定、各类淋巴廓清术式和联合脏器合并切除术式适应证及消化道重建术式的最新进展。术前应用示踪剂等并结合抗角蛋白或／和抗AE1／AE3免疫组化染色可提高前哨淋巴结转移的发现率。RT-PCR快速检测CEA mRNA和CK20 mRNA可发现淋巴结或／和腹膜微转移。各类胃癌缩小术式适应证为：癌灶〈1—3cm，≤N1，≤T1。≤Ⅱa/b；腹主动脉周围淋巴廓清术适应证为：≥T2，≥N2，≥Ⅱa，H0，≤P0/1，LM0,M0；联合脏器合并切除术适应证为：≥T3，≥N1/2，≥Ⅲa≤P0/1。LM0，M0,可达根治度A或B。全胃切除后空肠贮袋可以增加术后早期食物摄入量和体重。也可提高长期生活质量，其中间置空肠贮袋和双肠袋术式尤为引人关注。精确分期是选择各类切除术式的基础，合理切除和重建可延长生存时间。改善生活质量。

To overview several problems focused on the clinical surgery for gastric cancer. Randomized retrieve clinical control studies with English articles or English abstracts have been investigated in this paper, mainly for PLN detection, micrometastasis of peritoneal and lymphatic nodes and operative indications for less invasive surgery, super-expanded radical resection, combined resection of neighbor organs and re-construction after total gastrectomy. Tracing factors for detecting PLN using anti-cytokeratin or/and anti-AE1/AE3 immunohistochemical staining could increase the positive metastasis detection of lymphatic nodes. The RT-PCR for the detection of survivin mRNA and/or CEA-mRNA could further improve the positive detection of micrometastasis occurred in abdominal cavity and lymphatic nodes. Operative indications for different types of less invasive operation were the following： tumor diameter 〈 1-3 cm, ≤N1, ≤ Ti, ≤Ⅱa/b. The indications for superextensive radical resection of lymphatic nodes around abdominal aortic artery could be described as ≥ T2, ≥ N2,≥ Ⅱa, H0, ≤ P0/1, LM0, M0. The indications for the combined resection of invading organs were as follows： invading the neighbouring organs with enblock resection, and ≥T3,≥N1/2,≥Ⅲa, ≤P0/1 ,LM0,M0, sharing the resectibility A and B. In the early stage of the reconstruction after total gastrectomy, jejunal pouch seamed to improve the food intake and in crease the body weight. The quality of life were improved from the reconstruction of jejunal pouch in a long-term follow-up study. Among them, the interpositioned jejunal pouch was one of the most dramatic methods. The accuracy staging is quite important basement to sclectf different types of operation in order to prolong the survival time and improve the patient＇s quality of life.