胃癌腹膜转移治疗的研究进展(1)
[摘要] 胃癌腹膜转移发病率高，生存期短，是晚期胃癌死亡的主要原因之一。尽管胃癌腹膜转移的诊疗措施在不断进步，但胃癌腹膜转移患者的预后仍较差。有效预防胃癌腹膜转移的发生与胃癌腹膜转移的治疗同等重要。腹膜转移高危人群给予预防性腹腔热灌注化疗、术中腹腔灌注化疗、术后早期腹腔化疗及术后辅助化疗，可改善患者的预后。胃癌腹膜转移的治疗以全身化疗为主，可联合多种治疗手段，包括腹腔灌注化疗、靶向治疗及免疫治疗等，特别是转化治疗可明显改善胃癌腹膜转移患者的预后，但转化治疗人群的选择、方案的选择及转化的时机仍是目前的重点和难点。本文将对近年来胃癌腹膜转移治疗的研究现状进行概述，从而为临床实践提供一定的参考。
[关键词] 胃癌;腹膜转移;预防;治疗
[中图分类号] R735.2 [文献标识码] A [文章编号] 1673-7210(2020)02(a)-0028-05
[Abstract] Peritoneal metastasis of gastric cancer has high incidence and short survival time， which is one of the main causes of death in advanced gastric cancer. In spite of several advances have been made in diagnosis and treatment， the prognosis of patients with peritoneal metastasis is still lower. Effective preventive measures are as important as treatment of peritoneal metastasis. Hyperthemic intraperitoneal perfusion chemotherapy， extensive intraoperative peritoneal lavage， early postoperative intraperitoneal chemotherapy and postoperative adjuvant chemotherapy can improve the prognosis of patients with peritoneal metastasis in high-risk groups. The systemic chemotherapy is the main treatment for peritoneal metastasis of gastric cancer， which can be combined with a variety of treatment methods， including intraperitoneal chemotherapy， targeted therapy and immunotherapy. In particular， the conversion therapy can significantly improve the prognosis of gastric cancer patients with peritoneal metastasis. However， the selection of the groups， the regimens and the timing of the conversion therapy are still the current focus and difficulty. This article summarizes the research status of treatment for peritoneal metastasis of gastric cancer in recent years， thus providing some references for the clinical practice.
[Key words] Gastric cancer; Peritoneal metastasis; Prevention; Treatment
胃癌是全球第五大惡性肿瘤，也是全球第三大癌症相关死亡原因，对人类的健康造成了严重的威胁。在我国，胃癌的发病率和死亡率分别居恶性肿瘤的第三位及第二位。胃癌的转移是造成胃癌高死亡率的主要原因，其中，腹膜转移是进展期胃癌最常见的转移方式，占40%～63%。胃癌腹膜转移患者的中位生存期仅有4个月，是造成胃癌高死亡率的重要原因之一[1]。因此，有效预防胃癌腹膜转移的发生并进行精准的个体化治疗对提高晚期胃癌患者的生存率和生存质量至关重要。本文通过探究胃癌腹膜转移的治疗现状，以对胃癌腹膜转移的临床治疗提供参考。
1 胃癌腹膜转移的预防治疗
对于胃癌腹膜广泛转移的患者，任何治疗对延长患者的生存期均不会有很好的获益，只有积极采取有效的预防措施，才能延长患者生命，提高其生活质量。在胃癌手术中，严格遵守无瘤术操作原则，尽量避免手术操作导致的癌细胞在腹腔内脱落种植。对于有胃癌腹膜转移高危因素的患者，可采取预防性腹腔热灌注化疗(hyperthemic intraperitoneal perfusion chemot-herapy，HIPEC)、术中广泛腹腔灌洗(extensive intraoperative peritoneal lavage，EIPL)、术后早期腹腔化疗(early postoperative intraperitoneal chemotherapy，EPIC)、术后全身辅助化疗等对患者进行预防性治疗。, 百拇医药(韩博涵 吕慧芳 陈小兵)
[关键词] 胃癌;腹膜转移;预防;治疗
[中图分类号] R735.2 [文献标识码] A [文章编号] 1673-7210(2020)02(a)-0028-05
[Abstract] Peritoneal metastasis of gastric cancer has high incidence and short survival time， which is one of the main causes of death in advanced gastric cancer. In spite of several advances have been made in diagnosis and treatment， the prognosis of patients with peritoneal metastasis is still lower. Effective preventive measures are as important as treatment of peritoneal metastasis. Hyperthemic intraperitoneal perfusion chemotherapy， extensive intraoperative peritoneal lavage， early postoperative intraperitoneal chemotherapy and postoperative adjuvant chemotherapy can improve the prognosis of patients with peritoneal metastasis in high-risk groups. The systemic chemotherapy is the main treatment for peritoneal metastasis of gastric cancer， which can be combined with a variety of treatment methods， including intraperitoneal chemotherapy， targeted therapy and immunotherapy. In particular， the conversion therapy can significantly improve the prognosis of gastric cancer patients with peritoneal metastasis. However， the selection of the groups， the regimens and the timing of the conversion therapy are still the current focus and difficulty. This article summarizes the research status of treatment for peritoneal metastasis of gastric cancer in recent years， thus providing some references for the clinical practice.
[Key words] Gastric cancer; Peritoneal metastasis; Prevention; Treatment
胃癌是全球第五大惡性肿瘤，也是全球第三大癌症相关死亡原因，对人类的健康造成了严重的威胁。在我国，胃癌的发病率和死亡率分别居恶性肿瘤的第三位及第二位。胃癌的转移是造成胃癌高死亡率的主要原因，其中，腹膜转移是进展期胃癌最常见的转移方式，占40%～63%。胃癌腹膜转移患者的中位生存期仅有4个月，是造成胃癌高死亡率的重要原因之一[1]。因此，有效预防胃癌腹膜转移的发生并进行精准的个体化治疗对提高晚期胃癌患者的生存率和生存质量至关重要。本文通过探究胃癌腹膜转移的治疗现状，以对胃癌腹膜转移的临床治疗提供参考。
1 胃癌腹膜转移的预防治疗
对于胃癌腹膜广泛转移的患者，任何治疗对延长患者的生存期均不会有很好的获益，只有积极采取有效的预防措施，才能延长患者生命，提高其生活质量。在胃癌手术中，严格遵守无瘤术操作原则，尽量避免手术操作导致的癌细胞在腹腔内脱落种植。对于有胃癌腹膜转移高危因素的患者，可采取预防性腹腔热灌注化疗(hyperthemic intraperitoneal perfusion chemot-herapy，HIPEC)、术中广泛腹腔灌洗(extensive intraoperative peritoneal lavage，EIPL)、术后早期腹腔化疗(early postoperative intraperitoneal chemotherapy，EPIC)、术后全身辅助化疗等对患者进行预防性治疗。, 百拇医药(韩博涵 吕慧芳 陈小兵)
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