摘要
目的:探讨Ⅲ期胃癌的临床病理特点与外科治疗的效果。方法:采用不同治疗方法,其中D2淋巴结廓清组114例,D3淋巴结廓清组102例,术中放疗(IORT)组48例,腹腔化疗加肿瘤浸润淋巴细胞(TIL)腹腔灌注治疗组18例,并分析治疗效果。结果:本组总淋巴结转移率79.5%(384/484),转移度为41.2%(4169/10121);第1站、第2站、第3站和第4站淋巴结转移阳性率分别为68.8%、34.6%、19.6%和3.5%;浆膜与周围组织或器官粘连23.2%,其中癌性粘连12.5%。D3淋巴结廓清组1、3、5、8、10年生存率明显高于D2淋巴结廓清组,IORT组5年生存率明显增加;术中43℃(温热)蒸馏水+术后腹腔化疗+肿瘤浸润淋巴细胞(TIL)灌注治疗明显减少腹膜种植转移率。结论:Ⅲ期胃癌患者因其临床病理的特殊性,手术力求切除足够的胃和淋巴结,结合IORT及各种措施的腹腔灌注治疗,来提高Ⅲ期胃癌患者的长期生存率。
Objective:To study the Clinical pathology and the treatment of gastric carcinoma inⅢstage.Methods:484cases of gastric carcinoma inⅢstage were treated from1975～1997,and their clinicopathology feature were analysised,the different treatment methods were compared,including D 2 ?D 3 lymphadenectomy ,IORT and peritoneal infusing chemotherapy combi nation with TIL,and their effects were evaluated.Results:The total of lymph node metastasis(LNM)was79.5%(384/484),and the degree of LNM41.2%(4169/10121),The rates of LNM of N 1 ?N 2 ?N 3 and N 4 were68.8%?34.6%?19.6%and3.5%,respectively.The rate of serosa linking to peripheral tissue or organ was23.15%(112/484),the rate of cancerous link was12.5%(13/112).The sur vival rate of D3lymphadenectomy in1?3?5?8and10years were higher than that of D 2 lym phadenectomy,P<0.05～0.01.The5year survival rate in IORT was longer than in only group op eration,P<0.05～0.01.Peritoneal lavage with2000ml of43℃distilled water before closure of ab dominal wound and postoperation peritoneal infusing chemotherapy combining TIL decreased significantly the rate of peritoneal metastasis.Conclusion:Due to specificity of the gastric carcinoma inⅢstage,the surgical principle forⅢstage remains the extensive radical operation,in combi nation with IORT and different peritoneal infusing therapy to improve the5year survival rate.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2002年第11期781-784,共4页
Chinese Journal of Clinical Oncology
基金
上海市科委科技发展重点项目基金资助
关键词
胃癌
外科治疗
病理学
临床分析
Gastric carcinoma Ⅲstage Lymphadenectomy IORT Peritoneal infusing therapy
