本文選題：胃腫瘤　切入點(diǎn)：胃切除術(shù)　出處：《浙江大學(xué)》2017年碩士論文

【摘要】：[目的]探討新輔助化療聯(lián)合胃癌根治術(shù)治療進(jìn)展期胃癌的臨床療效。[方法]采用回顧性橫斷面研究方法。收集2004年6月至2009年12月浙江大學(xué)附屬第一醫(yī)院收治的73例行新輔助化療聯(lián)合胃癌根治術(shù)的進(jìn)展期胃癌患者的臨床資料。新輔助化療方案包括XELOX和FOLFOX兩種。新輔助化療結(jié)束后2周內(nèi)行胃癌根治術(shù)。術(shù)后按新輔助化療方案繼續(xù)化療。觀察指標(biāo):(1)新輔助化療不良事件。(2)手術(shù)及術(shù)后情況。(3)隨訪情況。采用門診和電話方式進(jìn)行隨訪,了解患者生存情況。隨訪時(shí)間截至2014年12月。偏態(tài)分布的計(jì)量資料以中位數(shù)(范圍)表示。采用Kaplan-Meier法繪制生存曲線。[結(jié)果](1)新輔助化療不良事件:73例患者中,38例采用XELOX方案,35例采用FOLFOX方案;新輔助化療中位周期為3個(gè)(1～7個(gè))。73例患者行新輔助化療期間,55例發(fā)生不良事件,其中1～2級(jí)47例,3～4級(jí)8例。(2)手術(shù)及術(shù)后情況:73例患者均成功完成D2胃癌根治術(shù),手術(shù)方式:遠(yuǎn)端胃切除術(shù)31例,全胃切除術(shù)40例,遠(yuǎn)端胃聯(lián)合膽囊切除1例,全胃聯(lián)合橫結(jié)腸切除1例。73例患者中,10例發(fā)生術(shù)后并發(fā)癥,其中胸腔積液3例、腹腔積液2例、吻合口出血2例、膽囊炎2例、淋巴漏1例。所有并發(fā)癥均經(jīng)保守治療后好轉(zhuǎn),無行二次手術(shù)或術(shù)后30d內(nèi)死亡患者。病理學(xué)TNM分期:Ⅰ～Ⅱ期22例,Ⅲ期45例,Ⅳ期4例,無法分期2例(為T0N1M0期)。3例患者完全緩解(T0N0M0期)。術(shù)后43例患者行化療。(3)隨訪情況:73例患者均獲得術(shù)后隨訪,隨訪時(shí)間為8-125個(gè)月,中位隨訪時(shí)間為51個(gè)月。73例患者生存時(shí)間為52個(gè)月,5年總體生存率為41.1%,5年疾病無進(jìn)展生存率為34.2%。[結(jié)論]XELOX和FOLFOX新輔助化療聯(lián)合胃癌根治術(shù)治療進(jìn)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，

本文編號(hào)：1685010