新辅助化疗联合营养支持在胃癌伴幽门梗阻患者的应用

Efficacies of neoadjuvant chemotherapy plus nutritional support in advanced gastric cancer complicated with pylori obstruction

目的 探讨新辅助化疗联合营养支持在胃癌伴幽门梗阻患者应用的方法及效果.方法 回顾性分析2004年1月至2013年6月间浙江省人民医院收治进行剖腹探查的116例胃癌伴幽门梗阻患者的临床资料.结果 116例患者中,62例（A组）术前接受新辅助化疗[FOLOX（奥沙利铂＋四氢叶酸钙＋5氟尿嘧啶）方案]联合营养支持,其中30例采用肠外营养支持（PN）,32例采用肠内营养支持（EN）;54例（B组）未接受新辅助化疗和营养支持直接手术探查.A组患者术前1 d,PN组和EN组血清蛋白及生活质量评分均较入院时有显著改善,但EN组优于PN组.A组的肿瘤切除率、根治性切除率（85.5%、45.2%）明显高于B组（64.8%、18.5%,均P〈0.05）.结论 营养支持,特别是EN能明显改善胃癌伴幽门梗阻行新辅助化疗患者营养状况,提高生活质量,且新辅助化疗联合营养支持能提高患者手术切除率.

Objective To explore the efficacies of neoadjuvant chemotherapy plus nutritional supports for gastric cancer complicated with pyloric obstruction. Methods Retrospective analyses were performed for a total of 116 patients of gastric cancer complicated with pyloric obstruction undergoing exploratory laparotomy from January 2004 to June 2013. Results Sixty-two patients （ group A ） received neoadjuvant chemotherapy （regimen of FOLFOX） plus preoperative nutritional support. And parenteral （PN, n = 30 ） and enteral （ EN, n = 32 ） nutritional supports were provided. Another 54 patients （ group B ） underwent exploratory laparotomy alone. The serum level of albumin and score of quality of life in group A at the last preoperative day improved significantly. And EN was better than PN. The rate of excision/radical excision of group A （85.5% ,45.2% ） was much higher than group B （64. 8% ,18. 5% ） （both P 〈0.05）. Conclusion Nutritional support, especially EN, can improve the nutritional status and quality of life in patients with gastric cancer complicated with pyloric obstruction. And nutritional support plus neoadjuvant chemotherapy increase the rate of tumor excision.