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目的评价胃癌新辅助化疗对转移性淋巴结的治疗效果。方法选择新疆喀什地区第一人民医院肿瘤外二科2008年3月-2012年12月收治的96例胃癌患者,随机分为常规手术组(48例)和新辅助化疗后手术组(48例),行CT等检查评估临床分期,新辅助化疗后手术组术前行3个周期新辅助化疗,两组均行D2胃癌根治术(第二站淋巴结全部清除)。根据两组术后常规淋巴结病理学检查比较治疗效果。结果胃体部癌及胃食管结合部癌包括中晚期胃体部癌及胃食管结合部癌(ⅢB、ⅢC期及Ⅳ期)新辅助化疗后手术组的术后淋巴结阳性率明显低于常规手术组(胃食管结合部癌进展期:新辅助化疗组淋巴结阳性率10.0%;常规手术组淋巴结阳性率24.8%;胃食管结合部癌晚期:新辅助化疗组淋巴结阳性率12.5%;常规手术组淋巴结阳性率37.1%;胃体部癌进展期:新辅助化疗组淋巴结阳性率8.0%;常规手术组淋巴结阳性率20.5%;胃体部癌晚期:新辅助化疗组淋巴结阳性率3.8%;常规手术组淋巴结阳性率29.8%;达到降低临床期和手术根治;胃窦癌包括中晚期胃窦癌(ⅢB、ⅢC期及Ⅳ期)新辅助化疗后手术组的术后淋巴结阳性率与常规手术组比较差异无统计学意义。结论新辅助化疗对于胃体部癌及胃食管结合部癌的患者,可以达到降低临床分期,减少阳性淋巴结数量,从而达到减少淋巴结癌肿残留、降低局部复发率,使患者生存期延长成为可能,值得推广应用;而胃窦癌新辅助化疗需进一步研究。
Objective To evaluate the therapeutic effect of neoadjuvant chemotherapy for metastatic lymph nodes in gastric cancer. Methods A total of 96 patients with gastric cancer admitted to the Second Affiliated Hospital of Kashgar People’s Hospital of Kashgar from March 2008 to December 2012 were randomly divided into two groups: conventional surgery (48 cases) and neoadjuvant chemotherapy (48 cases) CT was performed to assess the clinical stage. Neoadjuvant chemotherapy was given to the operation group for 3 cycles of neoadjuvant chemotherapy before operation. Both groups underwent radical gastrectomy for D2 gastric cancer (all lymph nodes were removed from the second station). According to two groups of conventional lymph node pathological examination to compare the therapeutic effect. Results The rate of postoperative lymph node positive rate of gastric cancer and gastroesophageal junction cancer in advanced gastric cancer and gastroesophageal junction cancer (ⅢB, ⅢC and Ⅳ) was significantly lower than that of routine surgery Group (the rate of lymph node positive rate in neoadjuvant chemotherapy group was 10.0%; the positive rate of lymph node in routine operation group was 24.8%; the rate of node in gastroesophageal junction cancer was 12.5% in neoadjuvant chemotherapy group; the rate of lymph node in normal operation group was The positive rate was 37.1%. The gastric cancer progression rate was 8.0% in neoadjuvant chemotherapy group, 20.5% in routine operation group, and 3.8% in neoadjuvant chemotherapy group. The rate of lymph node in normal operation group The positive rate of lymph node was 29.8%; the clinical stage and radical operation were reduced; the rate of postoperative lymph node positive rate in the patients with gastric antrum cancer including advanced gastric cancer (ⅢB, ⅢC and Ⅳ) after operation of neoadjuvant chemotherapy was significantly lower than that of the conventional operation group No statistical significance.Conclusion Neoadjuvant chemotherapy for gastric body cancer and gastroesophageal junction cancer patients, can reduce the clinical stage, reduce the number of positive lymph nodes, so as to reduce residual lymph node cancer, reduce Local recurrence rate, making it possible to prolong the survival of patients, should be widely applied; and antrum cancer neoadjuvant chemotherapy further study.