胃癌伴呕血术前介入治疗的临床研究(1)
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【摘要】 目的 探讨胃癌伴呕血术前化疗栓塞的疗效观察,不良反应及对手术切除率的影响。方法 胃癌伴呕血患者65例，分为化疗栓塞后手术组和单纯手术组。化疗栓塞后手术组30例，测量化疗栓塞后其大小、形态的变化，肿瘤坏死的程度及不良反应，7~15 d后行手术切除，统计手术时间，术中出血量，手术切除率及生存时间，并与单纯手术组35例进行比较。结果 ①化疗栓塞可使呕血消失、肿瘤发生一定程度的坏死，并使病变范围有所缩小，不良反应轻微。②化疗栓塞后再行手术切除，不仅可提高手术切除率，还可减少手术时间及术中出血量，延长了生存时间。结论 胃癌伴呕血术前化疗栓塞，创伤轻微，疗效显著，应作为术前的一项常规治疗手段。
【关键词】 胃癌；介入治疗;经动脉化疗栓塞；手术切除率
Clinical observation of the preoperative interventional therapy about stomach cancer going with hematemesis. XU Zhe. Hulun BeiEr peoples hospital, Neimeng province, 021008,China
【Abstract】 Objective To study the clinical curative effect and harmful reaction of the preoperative interventional chemotherapy and embolization about stomach cancer going with hematemesis and the effect for rate of operation removal.Methods 65 cases were divided into two groups:simple operation group, interventional chemotherapy embolization and operation group 30 cases, measuring the size form diversification, grade of tumor necrosis and harmful reaction.operation removal was performed after 7 to 15 days. Then accounting the time of operation,bleeding during operation the rate of operation removal survival time and studied comparatively with simple operation group 35 cases.Results ① chemotherapy embolization can cause the tumour necrosis and reduce the range of the pathological changes. Harmful reaction is lower ②operation removal after chemotherapy embolization not only can increase the race of operation removal but also decrease the time of operation and bleeding during operation prolong the survival time. Conclusion Preoperative interventional chemotherapy embolization about cancer going with hematemesis has little hurt and remarkabla.It should be a general treatment measure.
【Key words】 Stomach cancer; Interventional;Artery chemotherapy and embolization;The rate of operation removal
胃癌是最常见的消化管恶性肿瘤，其发病率和死亡率分别占我国全部恶性肿瘤的18.2%和25%，由于胃癌早期无特异性的临床表现，常易被误诊为胃炎或其他胃良性病变，确诊时91%以上已为进展期，并多已有局部组织，淋巴结，临近脏器转移。多年来，外科扩大根治切除术是治疗胃癌的主要手段，但由于患者就诊时多属晚期，单纯手术切除的疗效较差，5年生存率仅20%~50%。对不能手术切除，根治术后复发或姑息切除，改道和探查的胃癌患者主要采用以静脉途径化疗和放疗为主要措施的综合治疗，但其有效率较低，且全身化疗存在着局部药物浓度低，毒副作用大的缺点。近年来，随着影像和介入技术的发展，动脉灌注化疗和动脉化疗加栓塞在胃癌的治疗中取得了良好的疗效，特别对胃癌伴呕血术前化疗栓塞取得了良好的效果。我院已开展了此项介入治疗2005年1月至2011年1月共诊治胃癌伴呕血患者65例进行总结，并与对照组进行比较，评价化疗栓塞术的疗效，不良反应及对手术切除的作用。
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