伊立替康新輔助化療在進展期胃癌的臨床意義

王綏能 梁賢文 孫光 侯開慶 彭勃

摘 ? 要：目的 ?探索以伊立替康為主導的化療方案對進展期胃癌新輔助化療的可行性及安全性。方法 ?選擇我院2008年6月～2017年10月收治的進展期胃癌患者73例，術前給予伊立替康、亞葉酸鈣、5-氟尿嘧啶聯合化療兩個周期后手術。記錄患者化療的有效率及毒副反應。結果 ?患者的毒副反應主要表現在血液系統及胃腸管系統，泌尿系統、心血管系統及神經系統未見明顯不良反應。有1例因較為嚴重的骨髓抑制而提前結束化療，其余均順利完成。參照實體瘤療效評估標準（RECIST），化療有效率為78.13%，無效率為21.88%。結論 ?胃癌患者對伊立替康聯合亞葉酸鈣、5-氟尿嘧啶的新輔助化療方案有較好的耐受性，且該方法有較好的療效。

關鍵詞：進展期胃癌;新輔助化療;伊立替康;亞葉酸鈣;5-氟尿嘧啶

中圖分類號：R735.2 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 文獻標識碼：A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? DOI：10.3969/j.issn.1006-1959.2018.24.050

文章編號：1006-1959（2018）24-0164-03

Abstract：Objective ?To explore the feasibility and safety of irinotecan-based chemotherapy regimen for neoadjuvant chemotherapy for advanced gastric carcinoma.Methods ?73 patients with advanced gastric carcinoma admitted to our hospital from June 2008 to October 2017 were enrolled. Two cycles after irinotecan， leucovorin and 5-fluorouracil were given before surgery. The chemotherapy efficiency and toxicity of the patients were observed. side effects.Results ?The patient's toxic and side effects were mainly manifested in the blood system and gastrointestinal system. No obvious adverse reactions were found in the urinary system， cardiovascular system and nervous system.1 patient had early termination of chemotherapy due to more severe myelosuppression， and the rest were successfully completed. According to the solid tumor evaluation criteria （RECIST）， the effective rate of chemotherapy was 78.13%， and the ineffective rate was 21.88%.Conclusion ?Gastric carcinoma patients have better tolerance to irinotecan combined with calcium leucovorin and 5-fluorouracil， and this method has a good effect.

Key words：Advanced gastric carcinoma;Neoadjuvant chemotherapy;Irinotecan;Leucovorin;5-fluorouracil

胃癌（gastric carcinoma）是最常見的消化道腫瘤，近年來，其發病率遂漸上升，且有年輕化的趨勢[1]。胃癌惡性程度高，治療效果差，年生存率僅為30%～50%[2]。外科手術仍是最有效的治療手段，但往往手術時已有亞轉移灶存在，術后易復發、轉移率較高，總體預后差[3]。目前，國內外學者已基本認同新輔化療能使胃癌患者獲益，但化療方案眾多，其療效亦有差別。我科自2008年開始開展新輔助化療治療手術治療胃癌患者，取得了較好的療效，現報道如下。

1 資料與方法

1.1一般資料 ?選擇中南大學湘雅海口醫院胃腸外科2008年6月～2017年10月收治的進展期胃癌患者73例。納入標準：①經病理確診為胃癌患者，經胃鏡或CT檢查，臨床分期≥Ⅲb期，手術切除困難。……