中国实用外科杂志

中国实用外科杂志

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晚期胃癌转化治疗后手术切除13例疗效分析

甘强均，张    启，李豪杰，唐兆庆，汪学非，孙益红，刘凤林   

  1. 复旦大学附属中山医院普外科，上海  200032
  • 出版日期:2017-10-01 发布日期:2017-10-11

  • Online:2017-10-01 Published:2017-10-11

摘要：

目的    观察不可切除晚期胃癌转化治疗的疗效并探讨其安全性。方法    回顾性分析2014年1月至2017年7月复旦大学附属中山医院收治的13例经转化治疗后行手术切除的晚期胃癌病人的临床资料。结果    转化治疗后，9例病人获得部分缓解，4例为疾病稳定。术中清扫淋巴结（47.5±11.7）枚，手术时间（180.9±38.2）min，术中出血（203.9±92.3）mL，术中均未输血；胃管留置时间为（52.0±30.8）h，引流管放置时间为（170.2±47.0）h，
恢复流质饮食时间为（122.0±24.3）h，恢复半流质饮食时间为（154.9±32.1）h，术后病人住院时间为（8.7±2.0）d。术后共有3例病人发生并发症，其中2例为肺部炎症，1例为腹腔残余感染；Clavien-Dindo并发症分级Ⅱ级2例、Ⅲa级1例。无非计划再手术及住院期间死亡病例。13例病人中位无进展生存期为16.3个月，中位生存期为18.8个月。结论    虽然转化治疗的晚期胃癌病人术后并发症发生率有所增加，但部分病人生存获得明显改善，故转化治疗可作为晚期胃癌的重要治疗手段之一。

关键词: 晚期胃癌, 转化治疗, 安全性, 疗效

Abstract:

Eeffective analysis of conversion therapy for advanced gastric cancer: A report of 13 cases        GAN Qiang-jun，ZHANG Qi，LI Hao-jie，et al. Department of General Surgery，Zhongshan Hospital，Fudan University，Shanghai 200032，China
Corresponding author：LIU Feng-lin，E-mail：liu.fenglin@zs-hospital.sh.cn
Abstract    Objective    To analyze the efficacy and safety of conversion therapy for advanced gastric cancer. Methods The clinical data of 13 cases of advanced gastric cancer underwent gastrectomy with D2 lymph node dissection after conversion therapy between January 2014 and July 2017 at Zhongshan Hospital，Fudan University were analyzed retrospectively. Results    After conversion therapy，9 cases received PR，4 cases were SD. In all 13 cases，the number of lymph nodes resected was (47.5±11.7) ; the surgical time was (180.9+38.2) min; the intraoperative blood loss was (203.9 + 92.3) mL; and no blood transfusion was performed during operation. The time of gastric tube indwelling was (52.0 + 30.8) h; the time of drainage tube placement was (170.2+47.0) h; the time to first liquid intake was (122.0+24.3) h; the time to first semifluid intake was (154.9+32.1) h; the postoperative hospital stay was (8.7+2.0) d. There were three cases of post-operative complications; one was intra-abdominal abscess and the rest two were pulmonary inflammation. According to Clavien Dindo classification for post-operative complications，only one was grade Ⅲa and the rest got grade Ⅱ. There were no unplaned reoperation and death during hospitalization.The median PFS (progression-free survival) was 16.3 months; the median OS (overall survival) was 18.8 months. Conclusion    Although conversion therapy increases the risk of postoperative complications slightly，some patients with advanced gastric cancer do get significant survival benefit; conversion therapy can be one of the important treatment methods for advanced gastric cancer.

Key words: advanced gastric cancer, conversion therapy, safety, efficacy