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胃肠吻合术联合术后化疗治疗不能根治切除伴幽门梗阻的进展期胃癌

目的探讨不能根治性切除伴幽门梗阻进展期胃癌行胃肠吻合结合术后化疗的效果。方法选择 37 例符合纳入及排除标准的病例，进行回顾性研究，分析手术相关数据，化疗效果和生存情况。结果手术后 4 周复查胃出口梗阻评分系统（GOOSS）的评分、体质量指数（BMI）、血红蛋白及白蛋白指标，除 BMI 外，其他 3 项指标均明显好转，与术前比较差异具有统计学意义（P<0.001，P=0.027，P=0.08）。化疗后肿瘤病灶缩小 23 例（62.2%），无明显变化 11 例（29.7%），肿瘤较前增大 3 例（8.1%）。化疗后转移淋巴结缩小或消失 17 例（68.0%），6 例（24.0%）无明显变化，2 例（8.0%）淋巴结较前增大。化疗前有腹水 20 例（54.1%），化疗后腹水减少甚至消失 17 例（85.0%），腹水无明显变化 3 例（15.0%），无腹水增多者。本组 37 例患者中获随访 35 例，随访率为 94.6 %；随访时间 6～30 个月，平均 17.8 个月；本组患者的生存时间 6～30 个月，中位生存时间 11.6 个月。结论对于不能根治性切除的合并幽门梗阻的进展期胃癌，胃肠吻合术后联合化疗可获得较满意的治疗效果。

额肌筋膜瓣移位修复一例复发性额骨骨囊肿切除后缺损

Analysis on Effect of Neoadjuvant Chemotherapy of Different Differentiated Grades of Locally Advanced Gastric Cancer

ObjectiveTo evaluate the influence of pathological differentiation in the effect of preoperative chemo-therapy for patients with locally advanced gastric cancer (LAGC). MethodsThirty-two patients with LAGA received preoperative chemotherapy with oxaliplatin and capecitabine (XELOX regimen).According to the pathological examina-tion, patients were classified into better (well and moderate, 16 cases) and poorly (16 cases) differentiated groups, and the clinical response rate, type of gastrectomy, and negative tumor residual rate were compared between the two groups.Morphological changes and toxic reactions were monitored after chemotherapy. ResultsThe results showed that the clinical response rate in the better differentiated group was significantly higher than that in the poorly differentiated group (100% vs.6.4%, P=0.000).The partial gastrectomy rate in the better differentiated group was significantly higher than that in the poorly differentiated group (87.5% vs.25.0%, P=0.000).A significant shrinking of tumor size and necrosis of tumor tissues caused by chemotherapy could be observed. ConclusionThe better differentiated group with locally advanced gastric cancer is suitable for preoperative chemotherapy with XELOX regimen, and as a result of effective preoperative chemotherapy, much more gastric tissue can be preserved for better differentiated group.