Shima Yasuo, Horimi Tadashi, Nishioka Yutaka, Okabayashi Takahiro, Hamada Madoka, Ishikawa Tadanori, Shibuya Yuichi, Sakurama Kazufumi, Nishie Manabu, Iwata Jun, Tsuji Akihito, Morita Sojiro
Dept. of Surgery, Kochi Municipal Central Hospital.
Gan To Kagaku Ryoho. 2003 Dec;30(13):2115-8.
We report two resected cases of advanced gastric cancer with peritoneal dissemination after successful treatment with TS-1 plus low-dose CDDP. Patient 1 presented with right hypochondralgia and underwent laparotomy with diagnosis of type 4 gastric cancer by gastrointestinal fiberscopy. However, the tumor was judged to be unresectable due to peritoneal dissemination, and chemotherapy was performed. At the completion of course 1, he underwent laparotomy again. Although the tumor involved the body of the pancreas and transverse colon, there was no peritoneal dissemination. Therefore, a total gastrectomy was performed with distal pancreatectomy, partial colectomy, cholecystectomy, and D2 lymph node dissection. Patient 2 presented with anorexia and was diagnosed with type 3 gastric cancer by gastrointestinal fiberscopy. CT revealed the tumor was unresectable due to peritoneal dissemination, and so chemotherapy was performed. He underwent laparotomy at the completion of course 3. There was no peritoneal dissemination, so a total gastrectomy was performed with cholecystectomy and D2 lymph node dissection. Both patients remain alive and in good condition without any signs of recurrence after surgery.
我们报告了两例晚期胃癌伴腹膜播散的病例，这两例患者在接受替吉奥（TS-1）联合低剂量顺铂（CDDP）成功治疗后接受了手术切除。病例1以右季肋部疼痛为表现，经纤维胃镜检查诊断为4型胃癌后接受了剖腹手术。然而，由于腹膜播散，该肿瘤被判定为无法切除，遂进行了化疗。在第1疗程结束时，他再次接受了剖腹手术。尽管肿瘤侵犯了胰体和横结肠，但未发现腹膜播散。因此，实施了全胃切除术，同时进行了远端胰腺切除术、部分结肠切除术、胆囊切除术及D2淋巴结清扫术。病例2以食欲不振为表现，经纤维胃镜检查诊断为3型胃癌。CT检查显示由于腹膜播散，该肿瘤无法切除，于是进行了化疗。在第3疗程结束时，他接受了剖腹手术。未发现腹膜播散，因此实施了全胃切除术，同时进行了胆囊切除术及D2淋巴结清扫术。两名患者术后均存活且状况良好，无任何复发迹象。
