多学科协作下新辅助化疗对进展期胃癌手术效果的影响

Influence of neo-adjuvant chemotherapy on progrsssive gastric cancer operation withi multi.disciplinary team

目的通过多学科协作（MDT）诊治模式下新辅助化疗在进展期胃癌中的应用，探讨新辅助化疗对胃癌手术过程和结果的影响。方法回顾性分析施行MDT模式（45例）和非MDT模式（78例）治疗的123例胃癌患者的临床资料，通过分析术前及新辅助化疗后CT、胃镜及内镜超声结果，手术切除比率，术中发现的病理学改变、组织学改变以及手术结果指标的差异。结果CT、内镜超声及胃镜下发现肿瘤明显缩小或者肿瘤消失的患者，MDT组占46．7％。在病理学改变的评价指标中，MDT组中腹腔粘连、腹腔积液、潜在性癌性幽门梗阻的发生率（分别为13．3％、8．9％、6．7％）均明显低于非MDT组（分别为28．2％、25．6％、33．3％）（均P〈0．05）。在组织学改变的评价指标中，MDT组中胃壁组织的质地较非MDT组更易碎和出血、胃周围组织的水肿发生率较非MDT组更高（均P〈0．05），但腹腔内腹膜的充血、水肿和大网膜的粘连／固定的发生率两组间的差异无统计学意义（P〉0．05）。在手术结果指标中，MDT组的手术时间、术中出血量也少于非MDT组（均P〈0．05），且MDT组术中行根治术切除概率及淋巴结清扫数目均明显高于非MDT组（均P〈0．05）。结论新辅助化疗对胃癌手术的操作有一定的影响，但通过更为规范和准确的手术操作可保证手术的顺利施行。优化MDT模式下的综合治疗方案并建立综合的新辅助化疗效果的术前评估体系。

Objective To discuss the influence of the progress and result in gastic cancer operation through application of neo-adjuvant chemotherapy in multi-disciplinary team（MDT）. Methods Clinical data of the patients treated in MDT model 45 cases and non-MDT model（78 cases） were respectively analyzed, and the index about pathologic change, histologic transform and operative result between the two groups were compared. Results In the index of pathologic change, the incidence of abdominal adherence and ascites and pyloric obstruction in MDT model group were obviously less than non-MDT model group（ P 〈 0.05 ）. In the index of histologic transform ,texture of mesentery in MDT model group was more fragile than non-MDT model group （ P 〈 0.05 ）. In the index of operative results, the operative duration and intra-operative bleeding in MDT model group were less than non-MDT model group （P 〈 0. 05 ）. Conclusion Neo-adjuvant chemotherapy has certain influence in gastric caneer operation, but the successful operations were performed by standard and correct procedures. Therefore, optimizing combined therapy in MDT model and constructing preoperative evaluation system with neo-adjuvant chemotherapy.