进展期胃癌的治疗

Treatment of advanced gastric carcinoma

目的 评价进展期胃癌 (AGC)综合治疗的意义。方法 结合作者的临床经验 ,介绍国内外有关AGC综合治疗的方法。结果及结论 在我国多数胃癌属AGC ,手术治疗的 5年生存率为 2 0 %～ 30 % ,可见胃癌仍是外科治疗效果不满意的恶性肿瘤。因此AGC必须进行综合治疗 ,包括手术、化疗、生物治疗等 ,尤其AGC根治术的概念应更新为 :(1)充分清除原发病灶及罹患脏器周围的组织 ;(2 )彻底清除胃周淋巴结 ;(3)完全消灭腹腔脱落的癌细胞。前两者要求规范化手术和推广标准术式 ;后者术中、术后必须进行腹腔内化疗。姑息性胃癌切除术和胃癌穿孔的积极手术治疗 。

Objective To evaluate the significance of combined therapy for advanced gastric carcinoma (AGC). Methods To introduce the combined therapy for AGC based on home and abroad literalures review combiation with author's clinical experience.Results and Conclusions Most patients with gastric carcinoma are AGC in China, the 5 year survival rate after operation is 20% to 30%, and surgery along is not the satisfactory therapy of gastric carcinoma. Therefore, AGC must be treated with combined therapy which includes surgery, chemical therapy and biologic therapy, etc. The concept of radical operation AGC should be renewed: (1) Adequately resection of primary carcinoma and surounding tisusses; (2) resecting perigastric lymph nodes; (3) eliminating the cells falling away the tumor in abdominal cavity completely. The first two cases need standard operation, which should be introduced. Intraperitoneal chemotherapy should be carried out after operation in the third case. Palliative operation and surgery for perforated gastric carcinoma will prolong survival period of the patient with AGC.