新辅助化疗联合胃癌根治术治疗进展期胃癌的临床疗效

发布时间：2018-03-30 07:54

  本文选题：胃肿瘤　切入点：胃切除术　出处：《浙江大学》2017年硕士论文

【摘要】：[目的]探讨新辅助化疗联合胃癌根治术治疗进展期胃癌的临床疗效。[方法]采用回顾性横断面研究方法。收集2004年6月至2009年12月浙江大学附属第一医院收治的73例行新辅助化疗联合胃癌根治术的进展期胃癌患者的临床资料。新辅助化疗方案包括XELOX和FOLFOX两种。新辅助化疗结束后2周内行胃癌根治术。术后按新辅助化疗方案继续化疗。观察指标:(1)新辅助化疗不良事件。(2)手术及术后情况。(3)随访情况。采用门诊和电话方式进行随访,了解患者生存情况。随访时间截至2014年12月。偏态分布的计量资料以中位数(范围)表示。采用Kaplan-Meier法绘制生存曲线。[结果](1)新辅助化疗不良事件:73例患者中,38例采用XELOX方案,35例采用FOLFOX方案;新辅助化疗中位周期为3个(1～7个)。73例患者行新辅助化疗期间,55例发生不良事件,其中1～2级47例,3～4级8例。(2)手术及术后情况:73例患者均成功完成D2胃癌根治术,手术方式:远端胃切除术31例,全胃切除术40例,远端胃联合胆囊切除1例,全胃联合横结肠切除1例。73例患者中,10例发生术后并发症,其中胸腔积液3例、腹腔积液2例、吻合口出血2例、胆囊炎2例、淋巴漏1例。所有并发症均经保守治疗后好转,无行二次手术或术后30d内死亡患者。病理学TNM分期:Ⅰ～Ⅱ期22例,Ⅲ期45例,Ⅳ期4例,无法分期2例(为T0N1M0期)。3例患者完全缓解(T0N0M0期)。术后43例患者行化疗。(3)随访情况:73例患者均获得术后随访,随访时间为8-125个月,中位随访时间为51个月。73例患者生存时间为52个月,5年总体生存率为41.1%,5年疾病无进展生存率为34.2%。[结论]XELOX和FOLFOX新辅助化疗联合胃癌根治术治疗进展期胃癌安全有效。
[Abstract]:[objective] to investigate the clinical efficacy of neoadjuvant chemotherapy combined with radical gastrectomy in the treatment of advanced gastric cancer. [methods] retrospective cross-sectional study was used to collect and treat the patients in the first affiliated Hospital of Zhejiang University from June 2004 to December 2009. Clinical data of 73 patients with advanced gastric cancer underwent neoadjuvant chemotherapy combined with radical gastrectomy. Neoadjuvant chemotherapy regimen included XELOX and FOLFOX. Radical gastrectomy was performed within 2 weeks after neoadjuvant chemotherapy. Postoperative neoadjuvant chemotherapy was performed with neoadjuvant chemotherapy. Therapeutic regimen continued with chemotherapy. Observation measures: 1) adverse events of neoadjuvant chemotherapy. 2) Surgical and postoperative conditions. 3) follow up. Follow up by outpatient and telephone. To understand the survival of patients. The follow-up time was up to December 2014. The metrological data of skewness distribution were expressed as median (range). The survival curve was drawn by Kaplan-Meier method. [results] 1) 38 out of 73 patients with adverse events of neoadjuvant chemotherapy were treated with neo-adjuvant chemotherapeutic adverse events. XELOX scheme was used in 35 cases and FOLFOX scheme was used in 35 cases. The median period of neoadjuvant chemotherapy was from 1 to 7. 73 patients had adverse events during neoadjuvant chemotherapy. Among them, 47 patients with grade 1, 2, grade 3, grade 4, 8 patients with grade 2) and 73 patients with gastric cancer were successfully treated with D2 radical gastrectomy. The operative methods included distal gastrectomy (31 cases), total gastrectomy (40 cases), distal gastrectomy combined with cholecystectomy (1 case), total gastrectomy combined with transverse colectomy (1 case) and postoperative complications occurred in 10 cases (3 cases of pleural effusion and 2 cases of celiac effusion). There were 2 cases of anastomotic bleeding, 2 cases of cholecystitis and 1 case of lymphatic leakage. All the complications were improved after conservative treatment without secondary operation or death within 30 days after operation. Pathological TNM staging: 鈪，

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