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| 胃癌肝转移化疗转化手术治疗的临床效果 |
| Clinical analysis of surgical treatment for gastric cancer with hepatic metastasis after preoperative chemotherapy and conversion therapy |
| 投稿时间：2018-02-12 |
| DOI：10.3969/j.issn.1000-0399.2018.07.008 |
| 中文关键词: 胃癌 肝转移 转化治疗 |
| 英文关键词: Gastric cancer Hepatic metastasis Conversion therapy |
| 基金项目:安徽省教育厅质量工程项目（项目编号：2016jyxm0538）；安徽省科技计划项目（项目编号：3101005002598） |
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| 中文摘要: |
| 目的 探究胃癌肝转移患者化疗治疗后，经多学科诊疗（MDT）评估为临床缓解，行转化手术治疗的临床疗效。方法 选取安徽医科大学第一附属医院2015年1月至2017年4月胃癌肝转移患者10例，采用化疗2~8个周期，术前MDT评估肿瘤分期，在D2根治术的基础上统计清扫淋巴结的数目、淋巴结转移率，观察不良反应和并发症发生情况，随访时间截止至2018年4月。结果 胃癌肝转移患者7例化疗后获得降期，降期率为70%（7/10）。胃癌肝转移化疗后增强CT下的T分期准确率为70%（7/10），N分期的准确率为50%（5/10）。MDT评估疗效的有效缓解率与病理学评估标准差异无统计学意义（P>0.05）。10例均顺利完成手术，其中8例患者行治愈性全胃切除+D2淋巴结清扫+食道与空肠Roux-en-Y吻合术，1例行治愈性远端胃大部切除+D2淋巴结清扫+近端胃与空肠Roux-en-Y吻合术，1例行全胃切除术+D2淋巴结清扫+食道与空肠Roux-en-Y吻合术。胃癌肝转移平均每例清扫淋巴结（22.40±11.19）枚，其中阳性淋巴结转移率33.04（74/224）。患者手术时间、住院时间、术中出血量分别为190.1 min、7.9 d及115.0 mL。9例为R0切除，1例为R1切除。10例全部治愈，无术后并发症。所有患者均获得随访，中位随访时间18.0（10~36）个月，中位生存时间为15.0（5~31）个月。结论 胃癌肝转移患者以MDT指导临床评估及术前化疗为基础转化后行根治术，可以提高患者的生存率。 |
| 英文摘要: |
| Objective To investigate the clinical efficacy of conversion surgery of patients with hepatic metastasis of gastric cancer after chemotherapy and multidisciplinary therapy(MDT) assessment of clinical remission. Methods The clinical data of patients with hepatic metastasis of gastric cancer who had undergone chemotherapy from Jan 2015 to April 2017 in the First Affiliated Hospital of Anhui Medical University were collected. Ten patients received 2~8 period of chemotherapy, preoperative MDT assessment of tumor stage was performed, and the number of cleared lymph nodes and lymph node metastasis rate were checked on the basis of D2 radical surgery. The adverse reactions and complications were observed. Patients were followed up to Februart 2018. Results Tumor stage was dropped in 7 patients with hepatic metastasis of gastric cancer after preoperative chemotherapy, and the drop rate of TNM stage was 70% (7/10). T staging accuracy of gastric cancer with hepatic metastasis after chemotherapy under the enhanced CT was 70% (7/10). N staging accuracy was 50% (5/10). There was no difference in the effective response rate of MDT assessment of clinical efficacy and evaluation standard of pathology (P>0.05). Ten cases successfully completed surgery. Eight cases underwent curative total gastrectomy+D2 lymph node dissection+esophagus and jejunum Roux-en-Y anastomosis, one case underwent curative distal gastrectomy+D2 lymph node dissection+proximal stomach and jejunum Roux-en-Y anastomosis, and one case underwent total gastrectomy+D2 lymph node dissection+esophagus and jejunum Roux-en-Y anastomosis. The average number of cleared lymph nodes in each patient with hepatic metastasis of gastric cancer was 22.40±11.19 with a 33.04% positive rate of cancer metastasis. Patients' operation time, hospital stay and operative blood loss was 190.1 min, 7.9 d and 115.0 mL, respectively. Nine patients received R0 resection and one patient R1 resection. Ten cases were all cured with no complications. All patients were followed up, with the median follow-up time of 18.0 (10~36)months and the median survival time of 15.0 (5~31)months. Conclusion Under the guidance of MDT, radical surgery after preoperative conversion chemotherapy can increase survival time of patients with hepatic metastasis of gastric cancer. |
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