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目的探讨联合脏器切除术治疗局部进展期胃癌的临床疗效及预后。方法对我院2002年8月至2009年12月收治的93例局部侵犯周围脏器的进展期胃癌患者的临床资料进行回顾性分析。结果联合胰体尾及脾切除24例,脾切除17例,横结肠部分切除10例,左肝外叶切除10例,胆囊切除7例,膈肌部分切除5例,胰体尾及脾切除加横结肠部分切除5例,双侧卵巢切除5例,左肝外叶及横结肠切除4例,胰十二指肠切除3例,肾上腺切除2例,联合胰体尾、脾、左肝外叶、部分膈肌及左肾上腺切除1例。术前新辅助化疗25例(26.88%),术后病理肿瘤缓解分级评分:0级4例,1级6例,2级8例,3级5例,4级2例,缓解率为84.0%。术后并发症发生率为31.18%,死亡率为4.30%,1年、3年生存率分别为50.11%和26.12%。结论联合脏器切除术是治疗局部进展期胃癌有效的手段,可提高术后生存率。术前辅助化疗能在一定程度上提高手术切除率和术后生存率。
Objective To investigate the clinical efficacy and prognosis of combined organ resection in the treatment of locally advanced gastric cancer. Methods A retrospective analysis was performed on the clinical data of 93 patients with advanced gastric cancer who had locally invaded peripheral organs from August 2002 to December 2009 in our hospital. Results Combined pancreas tail and spleen resection in 24 cases, splenectomy in 17 cases, transverse colon partial resection in 10 cases, left hepatic lobectomy in 10 cases, cholecystectomy in 7 cases, diaphragm resection in 5 cases, pancreatic body tail and splenectomy plus transverse colon portion Resection in 5 cases, bilateral ovariectomy in 5 cases, left extrahepatic and transverse colon resection in 4 cases, pancreatoduodenectomy in 3 cases, adrenalectomy in 2 cases, combined pancreatic body tail, spleen, left extrahepatic lobe, part of the diaphragm and Left adrenal resection in 1 case. Preoperative neoadjuvant chemotherapy in 25 cases (26.88%), postoperative pathological tumor remission grade score: 0 in 4 cases, 1 in 6 cases, 2 in 8 cases, 3 in 5 cases, 4 cases in 2 cases, the response rate was 84.0% . The incidence of postoperative complications was 31.18%, the mortality rate was 4.30%, and the 1-year and 3-year survival rates were 50.11% and 26.12% respectively. Conclusion Combined organ resection is an effective treatment for locally advanced gastric cancer, which can improve the postoperative survival rate. Preoperative adjuvant chemotherapy can improve the surgical resection rate and postoperative survival rate to a certain extent.