摘要
胃癌严重威胁人类健康,超过70%的初诊病人已属进展期或伴转移。目前存在“三高”现象:进展期胃癌比例高,不必要的剖腹探查率偏高,以及非R0切除率偏高。腹腔镜探查可发现:(1)腹腔内隐匿、影像学检查无法诊断的微小转移病灶;(2)明确已侵犯邻近脏器;(3)通过腹腔灌洗发现腹腔游离癌细胞,从而精准分期以确定合理的治疗方案。明确T4b分期,采取积极的术前治疗。发现腹腔隐匿性转移灶,避免过度治疗。筛查脱落细胞,实施转化治疗。选择合适的新辅助治疗,进一步改善胃癌病人的预后。
Gastric cancer is the leading cause of cancer-related deaths in human.More than 70%patients present with advanced gastric cancer or with metastasis in clinic.There are three“higher ratio”of phenomenons at present including higher ratio of advanced gastric cancer,higher ratio of unnecessary laparotomy,and higher ratio of non-R0 radical gastrectomy.Diagnostic laparoscopy can be used:(1)to discover occult and micro enough metastatic lesions in the abdominal cavity which could not be diagnosed by current imaging examinations;(2)to determine whether gastric cancer invaded adjacent organs;(3)to identify intraperitoneal free cancer cells using peritoneal lavage.Then the precision staging would be gotten for reasonable treatment strategy.T4bstage is diagnosed for positive preoperative treatment.Intraperitoneal occult metastatic lesions are found to avoid unnecessary gastrectomy.Separate cancer cells are screened for conversion therapy.The prognosis of patients with gastric cancer could be improved further when the neoadjuvant therapy is selected.
作者
聂明明(综述)
朱正纲(审校)
NIE Mingming;ZHU Zhenggang(Department of Gastrointestinal Surgery,Changhai Hospital,Navy Medical University,Shanghai 200433,China;Shanghai Key Laboratory of Gastric Neoplasm,Department of Surgery,Shanghai Institute of Digestive Surgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)
出处
《外科理论与实践》
2022年第4期365-369,共5页
Journal of Surgery Concepts & Practice
关键词
胃癌
腹腔镜探查
腹腔转移
临床分期
Gastric cancer
Laparoscopic exploration
Abdominal metastasis
Clinical staging
作者简介
通信作者:朱正纲,E-mail:zzg1954@hotmail.com
