摘要
目的：探讨胃癌术中照射部位、剂量和治疗结果。方法：对１０６例Ⅰ－Ⅳ期胃癌患者行Ｄ２或选择性Ｄ３术式，并采用不同照射剂量进行术中照射。对胃窦、体癌患者施行远侧胃大部切除术时，在腹腔动脉和肝十二指肠韧带区域进行术中照射。在胃体、贲门和全胃癌施行近侧胃大部切除或全胃切除时，将脾、胰体尾游离并翻向右侧，扩大术中照射野。此组病例的放疗结果与１９７５年至１９８９年期间４４１例胃癌单纯手术患者进行对照。结果：Ⅰ、Ⅳ期胃癌术中放疗不能提高术后生存期，Ⅱ、Ⅲ期胃癌能提高５年生存率１４．４％～２０％。其中Ⅲ期胃癌采用Ｄ２术式加术中放疗１～５年生存率有显著提高（Ｐ＜０．００１），而采用选择性Ｄ３手术加术中放疗术后３、４年生存率较单纯选择性Ｄ３显著提高（Ｐ＜０．００５）。结论：胃癌术中放疗能提高Ⅱ、Ⅲ期胃癌术后生存率，不增加术后并发症和死亡率。
Objective: To study the sites and doses of intraoperative radiotherapy(IORT) for gastric carcinoma and the effects of this mode of treatment. Methods: One hundred and six cases of Ⅰ-Ⅳ stages of gastric carcinoma received D2 or selective D3 resection operation and IORT were analyzed. For carcinoma of the antrum and the body, distal gastrectomy was supplemented by irradiation at the celiac axis and the hepatoduodenal figment area; while cancers of the cardia and upper third of or the whole stomach received proximal gastrectomy or total gastrectomy, plus more extended area of irradiation including the spleen and the body and tail of pancreas. The results of the present series(IORT group) were compared with those of 441 cases treated by resection alone during the period 1975-1989(control group). Results: Radiation dose below 30 Gy was safe. Cases belonging to stages Ⅰ andⅣ had not benefitted from operation+IORT; while those of stages Ⅱ and Ⅲ subjected to D2 resection+IORT had better 1-5 years survival rates as compared to those with simple resection (P<0.005). COncluSions: Stages Ⅱ and Ⅲ gastric carcinoma are appropriate candidates for resection+IORT, and no influence on the postoperative morbidity and mortality is expected
出处
《外科理论与实践》
2000年第4期254-256,共3页
Journal of Surgery Concepts & Practice
关键词
胃癌
手术中
生存期
放射治疗
Gastric cancer Resection Intraoperative radiotherapy Survival
