胃肠吻合术联合术后化疗治疗不能根治切除伴幽门梗阻的进展期胃癌_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

张震 ^1,2 , 苏妍卓 ¹ , 李畅 ¹ ,  孙立波 ¹

1. ;
2. ;

Corresponding author：

孙立波, Email: sunlibo0431@sina.com

Keywords：

进展期胃癌; 姑息治疗; 胃肠吻合; 化疗; 预后

DOI：

10.7507/1007-9424.201905117

Video：

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目的探讨不能根治性切除伴幽门梗阻进展期胃癌行胃肠吻合结合术后化疗的效果。方法选择 37 例符合纳入及排除标准的病例，进行回顾性研究，分析手术相关数据，化疗效果和生存情况。结果手术后 4 周复查胃出口梗阻评分系统（GOOSS）的评分、体质量指数（BMI）、血红蛋白及白蛋白指标，除 BMI 外，其他 3 项指标均明显好转，与术前比较差异具有统计学意义（P<0.001，P=0.027，P=0.08）。化疗后肿瘤病灶缩小 23 例（62.2%），无明显变化 11 例（29.7%），肿瘤较前增大 3 例（8.1%）。化疗后转移淋巴结缩小或消失 17 例（68.0%），6 例（24.0%）无明显变化，2 例（8.0%）淋巴结较前增大。化疗前有腹水 20 例（54.1%），化疗后腹水减少甚至消失 17 例（85.0%），腹水无明显变化 3 例（15.0%），无腹水增多者。本组 37 例患者中获随访 35 例，随访率为 94.6 %；随访时间 6～30 个月，平均 17.8 个月；本组患者的生存时间 6～30 个月，中位生存时间 11.6 个月。结论对于不能根治性切除的合并幽门梗阻的进展期胃癌，胃肠吻合术后联合化疗可获得较满意的治疗效果。

Citation： 张震, 苏妍卓, 李畅, 孙立波. 胃肠吻合术联合术后化疗治疗不能根治切除伴幽门梗阻的进展期胃癌. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(11): 1342-1345. doi: 10.7507/1007-9424.201905117 Copy

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1. Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol, 2006, 12(3): 354-362.
2. Ye S, Wang L, Zuo Z, et al. The role of surgery and radiation in advanced gastric cancer: A population-based study of Surveillance, Epidemiology, and End Results database. PLoS One, 2019, 14(3): e0213596.
3. Fujitani K, Ando M, Sakamaki K, et al. Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer. BJS Open, 2018, 1(6): 165-174.
4. Hu M, Zhang S, Yang X, et al. The prognostic value of lymph node ratio for local advanced gastric cancer patients with adjuvant chemoradiotherapy after D2 gastrectomy. Medicine (Baltimore), 2018, 97(44): e13079.
5. 魏波, 卫洪波. 进展期胃癌的治疗策略. 中华胃肠外科杂志, 2018, 21(10): 1099-1102.
6. Degiuli M, De Manzoni G, Di Leo A, et al. Gastric cancer: Current status of lymph node dissection. World J Gastroenterol, 2016, 22(10): 2875-2893.
7. Morita S, Fukagawa T, Fujiwara H, et al. The clinical significance of para-aortic nodal dissection for advanced gastric cancer. Eur J Sur Oncol, 2016, 42(9): 1448-1454.
8. 孙元水, 许晓东, 胡俊峰, 等. 新辅助化疗联合营养支持在幽门梗阻患者的应用. 中华医学杂志, 2014, 94(8): 584-586.
9. 邓国鹏, 曲建军, 翟升永, 等. 新辅助化疗对局部进展期胃癌营养状况影响的临床研究. 中华胃肠外科杂志, 2018, 21(3): 331-335.
10. Mazumdar M, Smith A, Schwartz LH. A statistical simulation study finds discordance between WHO criteria and RECIST guideline. J Clin Epidemiol, 2004, 57(4): 358-365.
11. Bulut E, Çiftçi T, Akhan O, et al. Palliation of malignant gastroduodenal obstruction: fluoroscopic metallic stent placement with different approaches. Diagn Interv Radiol, 2017, 23(3): 211-216.
12. Potz BA, Miner TJ. Surgical palliation of gastric outlet obstruction in advanced malignancy. World J Gastrointest Surg, 2016, 8(8): 545-555.
13. Miner TJ, Jaques DP, Karpeh MS, et al. Defining palliative surgery in patients receiving noncurative resections for gastric cancer. J Am Coll Surg, 2004, 198(6): 1013-1021.
14. Brimhall B, Adler DG. Enteral stents for malignant gastric outlet obstruction. Gastrointest Endosc Clin N Am, 2011, 21(3): 389-403.
15. Xiao C, Qian J, Zheng Y, et al. A phase Ⅱ study of biweekly oxaliplatin plus S-1 combination chemotherapy as a first-line treatment for patients with metastatic or advanced gastric cancer in China. Medicine (Baltimore), 2019, 98(20): e15696.
16. Martin-Romano P, Solans BP, Cano D, et al. Neoadjuvant therapy for locally advanced gastric cancer patients. A population pharmacodynamic modeling. PLoS One, 2019, 14(5): e0215970.
17. Sun LB, Zhao GJ, Ding DY, et al. Comparison between better and poorly differentiated locally advanced gastric cancer in preoperative chemotherapy: a retrospective, comparative study at a single tertiary care institute. World J Surg Oncol, 2014, 12: 280.
18. Kosaka T, Akiyama H, Miyamoto H, et al. Outcomes of preoperative S-1 and docetaxel combination chemotherapy in patients with locally advanced gastric cancer. Cancer Chemother Pharmacol, 2019, 83(6): 1047-1055.
19. Ryo S, Kanda M, Ito S, et al. The controlling nutritional status score serves as a predictor of short- and long-term outcomes for patients with stage 2 or 3 gastric cancer: analysis of a multi-institutional data set. Ann Surg Oncol, 2019, 26(2): 456-464.
20. Nelen SD, van Putten M, Lemmens VEPP, et al. Effect of age on rates of palliative surgery and chemotherapy use in patients with locally advanced or metastatic gastric cancer. Br J Surg, 2017, 104(13): 1837-1846.
21. Larssen L, Hauge T, Medhus AW. Stent treatment of malignant gastric outlet obstruction: the effect on rate of gastric emptying, symptoms, and survival. Surg Endosc, 2012, 26(10): 2955-2960.
22. Kano M, Hayano K, Hayashi H, et al. Survival benefit of neoadjuvant chemotherapy with S-1 plus docetaxel for locally advanced gastric cancer: a propensity score-matched analysis. Ann Surg Oncol, 2019, 26(6): 1805-1813.
23. Hosoda K, Watanabe M, Yamashita K. Re-emerging role of macroscopic appearance in treatment strategy for gastric cancer. Ann Gastroenterol Surg, 2018, 3(2): 122-129.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

胃肠吻合术联合术后化疗治疗不能根治切除伴幽门梗阻的进展期胃癌

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