进展期胃癌新辅助化疗后再手术疗效的临床研究

Clinical research on the surgical operation after preoperative neoajuvant chemotherapy in the treatment of advanced gastric carcinoma

目的探讨进展期胃癌行新辅助化疗后再手术的临床疗效。方法将2007年1月-2010年12月我院收治的进展期胃癌行新辅助化疗后再行手术治疗的患者23例(化疗组),与2003年1月-2006年12月未接受新辅助化疗单纯行手术治疗的患者19例(对照组)进行对照分析,观察新辅助化疗后临床有效率,新辅助化疗的毒副反应,比较两组的手术切除情况及手术并发症。结果化疗组肿瘤缩小或明显缩小者16例(69.6%)。化疗的毒副反应主要为胃肠道反应、骨髓抑制、及神经系统毒性,且多为轻度。经新辅助化疗后均进行手术评估,其中行根治性手术切除者17例(73.9%),对照组行根治性手术切除者10例(52.6%),化疗组根治性切除率明显高于对照组,有统计学意义(P<0.05)。手术并发症两组发生率均较低,差异不明显无统计学意义(P>0.05)。结论对于以往一期手术切除较为困难的进展期胃癌,术前行新辅助化疗,可提高手术切除率及治愈率。

【Objective】 To explore the clinical effect of the surgical operation after preoperative neoajuvant chemotherapy in the treatment of advanced gastric carcinoma.【Methods】 Clinical data of 92 cases of advanced gastric carcinoma which were treated with neoajuvant chemotherapy before surgical operation from January 2007 to December 2010,and the 19 cases,which were treated without neoajuvant chemotherapy before surgical operation from January 2003 to December 2006,were set as control.The total effective rate and the toxic action of neoajuvant chemotherapy were surveyed;comparisons of the surgical excision and the complications of operation in these two group were performed.【Resluts】16 tumors（69.6%） had shrunk or got smaller obviously.the major toxic action were gastrointestinal tract,bone marrow depression and the neurotoxicity with the mild level.the surgical evaluation towards the cases which were pre-treated with neoajuvant chemotherapy were performed,17 radical（73.9%）,while for the control,10 radical（52.6%）.the rate of radical resection of the chemotherapy was higher than that of control group（P0.05）.and there was on significant difference between the two group in the incidence of operative complication（P0.05）.【Conclusion】 The excision rate and cure rate were improved for the advanced gastric carcinoma which was difficult to excise in an issue of surgery by pre-treated with neoajuvant chemotherapy.