进展期胃癌的总体治疗分析

Analysis of surgical multimodality treatment in advanced gastric cancers

目的 :评价进展期胃癌以手术为主的综合性治疗效果。 方法 :总结并分析 10年间以根治性手术为主 ,联合手术前后综合性治疗 375例进展期胃癌的临床治疗结果。对所有患者进行D2或D3手术 ,术中和术后进行围手术期化疗 ,术后进行 6～ 8个疗程的化疗和免疫治疗。 结果 :本组手术切除率为 94 .4 % ,根治性切除率为 85 .3% ,术前介入治疗后肿瘤缩小率为 79%。 5年总生存率为 5 2 .3%。其中Ⅱ期为 83.5 % ,ⅢA期为 5 8.7% ,ⅢB和Ⅳ期分别为 39.2 %和 15 .9%。 结论 :进展期胃癌除了应规范手术方法外 ,手术前、后的综合性治疗是提高中。

Objectives: To observe the effects of surgical multimodality treatment in advanced gastric cancers. Methods:375 patients with advanced gastric cancers were treated by radical dissection,and combined pre and postoperative immunochemotherapy during the 10 years from Oct 1991 to Oct 2001.302 cases had received one bolus, and 73 patients had received more than twice with preoperative transcatheter arterial chemotherapy(TAC) .All patients were operated according to radical principles of gastric cancers by specific gastric treatment team. Peri operative chemotherapy and 6～8 courses of immunochemotherapy after the operation were carried out in our patients. Results:Surgical and radical resection rates were 94.4% and 85.3% respectively.The shrinkage rate of tumor mass was 79% after pre operative TAC based on CT imaging changes.The overall 5 year survival rate was 52.3%. And among them,the 5 year survival rates of TNM stage, ⅢA,ⅢB were 83.5%,58.7%,39.2% and 15.9% respectively. Conclusions: The effective surgical multimodality includes radical surgical resection, combined neoadjuvant treatment and post operative adjuvant immunochemotherapy, which appears to improve the resection rate and the 5 year survival rate in advanced gastric cancers.