新辅助化疗联合肠内营养治疗胃癌伴幽门梗阻的疗效分析
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摘要
目的:探讨胃癌伴幽门梗阻患者在肠内营养支持下同时予以新辅助化疗的疗效。方法:回顾性分析2016年6月至2018年6月在中国医科大学肿瘤医院诊断为胃癌伴幽门梗阻80名患者的临床资料。结果:80名患者中37名患者术前实施鼻空肠营养管肠内营养支持联合新辅助化疗(实验组),43名患者入院后直接手术治疗(对照组)。实验组患者术前1天的营养指标:前白蛋白、白蛋白、淋巴细胞计数均明显优于初次入院,且和对照组相比,在术前1天、术后第2、5天、术后1月的营养指标有统计学差异;在术后并发症方面,仅在术后低白蛋白上有统计学差异,余未体现统计学差异;实验组在根治性切除率、术后恢复情况均优于对照组。结论:新辅助化疗联合内营养支持能改善患者的营养状态、提高根治性切除率、缩短住院时间。
Objective: To investigate the efficacy of neoadjuvant chemotherapy in patients with gastric cancer and pyloric obstruction under the support of enteral nutrition. Methods: The clinical data of 80 patients with gastric cancer and pyloric obstruction diagnosed by the Cancer Hospital of China Medical University from June 2016 to June 2018 were retrospectively analyzed. Results: Thirty-seven of the 80 patients underwent preoperative jejunal nutrition tube enteral nutrition support combined with neoadjuvant chemotherapy( study group). 43 patients after admission underwent direct surgical treatment( control group). The nutritional indicators of the study group 1 day before surgery showed prealbumin,albumin,lymphocyte count were significantly better than the initial admission,and compared with the control group,there were statistical differences in nutritional indicators 1 day before surgery,2,5 days after surgery,and 1 month after surgery. In terms of postoperative complications,there was only statistical difference in postoperative low albumin,and the remaining did not reflect statistical differences. The rate of radical resection and postoperative recovery in the study group were superior to those in the control group. Conclusion: Neoadjuvant chemotherapy combined with enteral nutrition support can improve the nutritional status of patients,improve the rate of radical resection,and shorten the length of hospital stay.
Objective: To investigate the efficacy of neoadjuvant chemotherapy in patients with gastric cancer and pyloric obstruction under the support of enteral nutrition. Methods: The clinical data of 80 patients with gastric cancer and pyloric obstruction diagnosed by the Cancer Hospital of China Medical University from June 2016 to June 2018 were retrospectively analyzed. Results: Thirty-seven of the 80 patients underwent preoperative jejunal nutrition tube enteral nutrition support combined with neoadjuvant chemotherapy( study group). 43 patients after admission underwent direct surgical treatment( control group). The nutritional indicators of the study group 1 day before surgery showed prealbumin,albumin,lymphocyte count were significantly better than the initial admission,and compared with the control group,there were statistical differences in nutritional indicators 1 day before surgery,2,5 days after surgery,and 1 month after surgery. In terms of postoperative complications,there was only statistical difference in postoperative low albumin,and the remaining did not reflect statistical differences. The rate of radical resection and postoperative recovery in the study group were superior to those in the control group. Conclusion: Neoadjuvant chemotherapy combined with enteral nutrition support can improve the nutritional status of patients,improve the rate of radical resection,and shorten the length of hospital stay.
引文
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[18]WANG Zhiming,LI Guoli,WANG Zhenlong,et al.Application of enteral nutrition support in patients with gastric cancer and pyloric obstruction[J].Journal of Medical Postgraduate,2010,23(11):1182-1183.[汪志明,李国立,王震龙,等.肠内营养支持在胃癌伴幽门梗阻患者的应用[J].医学研究生学报,2010,23(11):1182-1183.]
[19]Fiori E,Lamazza A,Demasi E,et al.Endoscopic stenting for gastric outlet obstruction in patients with unresectable antro pyloric cancer.Systematic review of the literature and final results of a prospective study.The point of view of a surgical group[J].Am JSurg,2013,206(2):210.
[20]LI B,LIU HY,GUO SH,et al.Impact of early postoperative enteral nutrition on clinical outcomes in patients with gastric cancer[J].Genetics&Molecular Research Gmr,2015,14(2):7136-7141.
[2]Watanabe A,Maehara Y,Okuyama T,et al.Gastric carcinoma with pyloric stenosis[J].Surgery,1998,123(3):330.
[3]SUN Yuanshui,XU Xiaodong,HU Junfeng,et al.Application of neoadjuvant chemotherapy combined with nutritional support in patients with gastric cancer and pyloric obstruction[J].Chinese Journal of Medicine,2014,94(8):584-586.[孙元水,许晓东,胡俊峰,等.新辅助化疗联合营养支持在胃癌伴幽门梗阻患者的应用[J].中华医学杂志,2014,94(8):584-586.]
[4]TAN Qiuhui,DAI Yichen.Etiology and non-surgical treatment of pyloric obstruction[J].World Chin J Digestol,2014(28):4250-4256.[谈秋慧,戴益琛.幽门梗阻的病因和非手术治疗的研究进展[J].世界华人消化杂志,2014(28):4250-4256.]
[5]XU AM,HUANG L,LIU W,et al.Neoadjuvant chemotherapy followed by surgery versus surgery alone for gastric carcinoma:Systematic review and Meta-analysis of randomized controlled trials[J].PLo S One,2014,9(1):e86941.
[6]Yoshikawa T,Tanabe K,Nishikawa K,et al.Induction of a pathological complete response by four courses of neoadjuvant chemotherapy for gastric cancer:Early results of the randomized phase IICOMPASS trial[J].Ann Surg Oncol,2014,21(1):213-219.
[7]Cho H,Nakamura J,Asaumi Y,et al.Long-term survival outcomes of advanced gastric cancer patients who achieved a pathological complete response with neoadjuvant chemotherapy:A systematic review of the literature[J].Ann Surg Oncol,2015,22(3):787-792.
[8]Yoshikawa T,Rino Y,Yukawa N,et al.Neoadjuvant chemotherapy for gastric cancer in Japan:A standing position by comparing with adjuvant chemotherapy[J].Surg Today,2014,44(1):11-21.
[9]Sherman KL,Merkow RP,Bilimoria KY,et al.Treatment trends and predictors of adjuvant and neoadjuvant therapy for gastric adenocarcinoma in the United States[J].Ann Surg Oncol,2013,20(2):362-370.
[10]Wilke H,Preusser P,Fink U,et al.Preoperative chemotherapy in locally advanced and nonresectable gastric cancer:A phase IIstudy with etoposide,doxorubicin,and cisplatin[J].J Clin Oncol,1989,7(9):1318-1326.
[11]Tsuburaya A,Mizusawa J,Tanaka Y,et al.Neoadjuvant chemotherapy with S-1 and cisplatin followed by D2 gastrectomy with para-aortic lymph node dissection for gastric cancer with extensive lymph node metastasis[J].Br J Surg,2014,101(6):653-660.
[12]Hirakawa M,Sato Y,Ohnuma H,et al.A phase II study of neoadjuvant combination chemotherapy with docetaxel,cisplatin,and S-1 for locally advanced resectable gastric cancer:Nucleotide excision repair(NER)as potential chemoresistance marker[J].Cancer Chemotherapy&Pharmacology,2013,71(3):789-797.
[13]Valenti V,Hernandez-Lizoaín JL,Beorlegui MC,et al.Morbidity,mortality,and pathological response in patients with gastric cancer preoperatively treated with chemotherapy or chemoradiotherapy[J].J Surg Oncol,2011,104(2):124-129.
[14]Conroy T,Galais MP,Raoul JL,et al.Definitive chemoradiotherapy with FOLFOX versus fluorouracil and cisplatin in patients with oesophageal cancer(PRODIGE5/ACCORD17):Final results of a randomised,phase 2/3 trial[J].Lancet Oncology,2014,15(3):305-314.
[15]Choi WJ,Kim J.Nutritional care of gastric cancer patients with clinical outcomes and complications:A review[J].Clin Nutr Res,2016,5(2):65-78.
[16]Meyenfeldt MV.Cancer-associated malnutrition:An introduction[J].European Journal of Oncology Nursing,2005,9(Suppl 2):S35-S38.
[17]HU Jiankun,ZHANG Weihan,CHEN Xinzu.Laparoscopic gastrectomy combined with neoadjuvant chemotherapy for gastric cancer patients:From the view of the CLASS-03a trial[J].Chinese Journal of Gastrointestinal Surgery,2018,21(2):138-142.[胡建昆,张维汉,陈心足.从中国CLASS-03a研究的开展看腹腔镜手术联合新辅助化疗的胃癌治疗[J].中华胃肠外科杂志,2018,21(2):138-142.]
[18]WANG Zhiming,LI Guoli,WANG Zhenlong,et al.Application of enteral nutrition support in patients with gastric cancer and pyloric obstruction[J].Journal of Medical Postgraduate,2010,23(11):1182-1183.[汪志明,李国立,王震龙,等.肠内营养支持在胃癌伴幽门梗阻患者的应用[J].医学研究生学报,2010,23(11):1182-1183.]
[19]Fiori E,Lamazza A,Demasi E,et al.Endoscopic stenting for gastric outlet obstruction in patients with unresectable antro pyloric cancer.Systematic review of the literature and final results of a prospective study.The point of view of a surgical group[J].Am JSurg,2013,206(2):210.
[20]LI B,LIU HY,GUO SH,et al.Impact of early postoperative enteral nutrition on clinical outcomes in patients with gastric cancer[J].Genetics&Molecular Research Gmr,2015,14(2):7136-7141.