迄今,外科手术仍为胃癌的首选治疗手段,随着对既往外科治疗经验教训的不断分析与总结,同时,对肿瘤基础研究的深入以及其他综合治疗方法的进步,胃癌外科治疗已从原来单纯依赖解剖学为手术基础而逐渐发展为以肿瘤生物学行为为基本依据的新理念,使得胃癌的外科手术更趋合理,更符合“个体化”的要求。现谨就目前胃癌外科治疗中常遇见的有关问题进行探讨。
目的 总结我院35岁以下青年人胃癌43例的诊治经验。方法 对43例患者临床特征、诊断及治疗进行回顾性分析。结果 手术40例，根治性切除14例，姑息性切除9例，胃空肠吻合6例，单纯探查11例，切除率57.50%。术后3个月内死亡5例，4～12个月内死亡18例，12～24个月内死亡8例，生存2年以上9例，5年以上3例。误诊26例，误诊率60.46%。结论 青年人胃癌发病率低，恶性程度高，病程短，转移早，早期诊断率低，误诊率高，治疗关键是提高早期诊断率。
目的 系统评价华蟾素治疗胃癌的疗效。 方法 计算机检索Cochrane （2011年第3期），PubMed （1966年1月－2011年9月），EMBASE（1974年1月－2011年9月），中国生物医学数据库（CBM，1978年1月－2011年9月），维普（1989年1月－2011年9月），中国期刊全文数据库（1994年1月－2011年9月）；手工检索相关杂志。纳入华蟾素治疗胃癌的随机对照试验（RCT），对纳入的RCT进行质量评价，并用RevMan 5.0软件进行Meta分析。 结果 共纳入9个RCT，Meta分析结果显示：华蟾素联合常规化学疗法（化疗）治疗中晚期胃癌的有效率高于常规化疗组，且差异有统计学意义[RR=1.23，95%CI（1.03，1.46），P=0.02]，而1年生存率两组比较差异无统计学意义[RR=1.28，95%CI（0.69，2.36），P=0.43]。 结论 常规化疗加华蟾素治疗胃癌的疗效优于常规化疗，但因为纳入研究质量较低，尚需高质量、大样本、长期的随机对照试验进一步验证上述结论。
Objective To provide a current language for clinical and pathological discription of gastric cancer. Methods The literature in recent years on the distribution of lymph nodes and staging of gastric cancer were reviewed. Results The lymph nodes of gastric cancer are distributed near the blood vessel and organs of gastric milieu. To ensure radical gastrectomy rational and scientific, the anatomic structure of gastric milieu should be familiarized. Conclusion The excellent outcome of surgery will be achieved by the effective dissection and removel of lymph nodes in gastric cancer.
ObjectiveTo systematically review the value of mass screening of serum pepsinogen test for Asian population with high-risk gastric carcinoma. MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 12, 2013), CNKI, WanFang Data, VIP and CBM for diagnostic tests on serum pepsinogen test versus with pathological biopsy/X-ray examination (gold standard) between January 2004 and January 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was conducted using Meta-DiSc software (version 1.4). ResultsA total of 15 studies involving 180 934 subjects were included. ROC curve showed "shoulder-arm shape" distribution. The results of Spearman correlation analysis suggested a significance of the threshold effect (P=0.001). The results of meta-analysis showed that, the area under curve (AUC) was 0.74. ConclusionSerum pepsinogen has good value in the screening of gastric carcinoma among Asian permanent residents. Due to limited quality of studies, the above conclusion should be verified by conducting more high quality studies.
ObjectiveTo study the significance, methods, and technique of group No.6 lymphadenectomy of the laparoscopic gastrectomy with D2 lymph node dissection for distal gastric cancer. MethodsThe relevant data of the 141 examples of group No.6 lymphadenectomy of the laparoscopic gastrectomy with D2 lymph node dissection for distal gastric cancer from Jan.1, 2008 to Dec.31, 2011 were retrospectively analysized. ResultsOne hundred and forty-one patients were successfully completed the group No.6 lymphadenectomy of laparoscopic distal gastrectomy with D2 lymph node dissection. With the number of cases of operation increasing, the operation time, bleeding volume, incidence rate of complication, and the number of operation transit cases stepped down year by year, and the number of the lymph node dissection stepped up (P < 0.000 1). No case died of the lymphadenectomy of the group No.6 lymph node. The medium vessels of colon, pancreas, and the gastroduodenal artery were the anatomic landmarks of the group No.6 lymphadenectomy. The space between the anterior lobe and the posterior lobe of transverse mesocolon and the prepancreatic space were the important surgical plane to carry out the group No.6 lymphadenectomy. ConclusionsOnly a team shall complete a certain amount of the operation, take the medium vessels of colon, pancreas, and the gastroduodenal artery as the anatomic landmark, accurately identify the space between the anterior lobe and the posterior lobe of transverse mesocolon, and the prepancreatic space, and take operation on the correct surgical plane, shall the group No.6 lymphadenectomy conform to the principle of the radical cure of the tumour and achieve the aim of the minimal invasion.
目的 探讨HIF-1α和BAK蛋白在胃癌中的表达情况，以及二者在胃癌中的相互关系及作用。方法 应用免疫组化SABC染色法检测80例胃癌组织和20例正常胃组织中的HIF-1α和BAK蛋白的表达情况。结果 胃癌中HIF-lα和BAK蛋白的表达阳性率分别为56.3%（45/80）和67.5%（54/80），而在胃正常组织中分别为5.0%（1/20）和20.0%（4/20），二者在胃癌中的表达显著高于胃正常组织，其差异有统计学意义（P＜0.05）。HIF-1α蛋白表达与胃癌组织的浸润范围、分化程度及淋巴结转移有关（P＜0.05），与临床分期、年龄及性别无关（P＞0.05）；BAK蛋白表达与胃癌浸润及分化程度相关（P＜0.05），与淋巴结转移、临床分期、年龄及性别无关（P＞0.05）。胃癌组织中HIF-1α与BAK蛋白的阳性表达之间呈正相关（列联系数r=0.056，P＜0.05）。结论 HIF-1α与BAK蛋白在胃癌的临床分期及浸润转移中存在关系，这对于研究胃癌的发生和发展，以及对于探索以二者为靶点的抗肿瘤治疗有重要意义。
Objective To understand role of chemokines and their receptors in pathogenesis, progression, and metastasis of gastric cancer, and to provide a better approach for diagnosis and treatment of gastric cancer. Method The literatures about the relationship between chemokines and their receptors and gastric cancer were reviewed. Results There were about 50 various chemokines and their receptors abnormally expressed in the tumor microenvironment. The main types related gastric cancer were the CXC, CC and CX3C chemokines and their receptors, which could promote the proliferation, invasion, and metastasis of the gastric cancer through several pathways like mTOR pathway, JAK2-STAT3 pathway, etc.. Conclusions Chemokines and their receptors play an important role in occurrence and development of gastric cancer. Further studies on chemokines and their receptors will not only assist in early diagnosis of gastric cancer, as well as estimation of clinical prognosis, but also provide an intervention target for gastric cancer.
Objective To systematically review the current situation of health economics evaluation of gastric cancer screening. Methods The PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect the health economics evaluation studies on gastric cancer screening from January 1st, 1975 to September 30th, 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Then, qualitative analysis was performed. Results A total of 44 studies were included. Most of the targeted populations of the study were high-risk groups in areas with a high incidence of gastric cancer. Screening methods such as endoscopy and Helicobacter pylori infection detection were mainly evaluated in those studies. According to the results, about 47% of the studies evaluated a single screening method. A total of 35 studies showed that they established models, however, only a few calibrated the models. Conclusion Most studies of gastric cancer screening reviews neither calibrate the results nor consider the effect of smoking on the progression of gastric cancer. Those evaluated screening programs are limited.