胃癌患者全胃切除功能性空肠间置重建术后对化疗耐受性的临床观察

摘要] 目的 评估胃癌患者全胃切除，功能性空肠间置代胃重建术后辅助化疗的安全及耐受性。方法 40例进展期胃癌患者，实施全胃切除功能性空肠间置代胃代胃重建术，术后12~21 d，按XELOX方案辅助化疗：奥沙利铂130mg/m2静脉滴注，第1天，卡培他滨2000mg/m2/d口服，第1~14天， 每21天重复，共6疗程。结果 40例患者均无发生严重手术并发症，无围手术期及化疗相关死亡。28例患者顺利完成术后辅助化疗6疗程。中断化疗的12例，其中8例化疗1~3疗程后，因发生严重返流性食管炎无法进食，经对症支持治疗后无明显改善而中断化疗，停止化疗后严重返流性食管炎逐渐减轻好转；4例因出现3~4度血小板毒性，经化疗药物减量及辅助处理无效中断化疗，停止化疗后血小板逐渐恢复正常。结论 胃癌患者实施全胃切除，功能性空肠间置代胃重建术安全可行，术后按XELOX方案辅助化疗， 70.0%患者可耐受化疗毒副反应而顺利完成辅助化疗，但仍有30.0%患者因严重毒副反应被迫中断化疗，中断化疗主要原因是严重返流性食管炎和血小板毒性。

Evaluation of tolerance to chemotherapy in patients with functional jejunal interposition after total gastrectomy

ABSTRACT] BACKGROUND & OBJECTIVE: Patients with advanced gastric carcinoma underwent total gastrectomy show poor tolerance to chemotherapy because of not only the physiological and anatomical change of gastrointestinal tract but also the digestive toxicity and bone marrow depression caused by chemotherapy. Functional jejunal interposition(FJI) was gradually applied as an up-to-day reconstrutive method after total gastrectomy for it is more adaptative to the demic physiological and anatomical requirements. Our study is to investigate the operation safety and tolerance to the postoperative adjuvant chemotherapy of the patients with advanced gastric carcinoma underwent total gastrectomy and reconstruction of FJI. PATIENTS & METHODS: Total gastretomy and reconstruction of FJI were performed for forty patients with advanced gastric carcinoma from May 2005 to May 2008, and all patients received adjuvant chemotherapy at day 12 to day 21 after operation with XELOX regimen ( oxalliplatin 130mg/m2 , intravenous infusion at day 1 ,and capecitabine 2000mg/m2 ,per os , day1 to day 14, one cycle every 3 weeks for total 18 weeks).The operation safety and patients’ tolerance to the adjuvant chemotherapy were observed. RESULTS: Neither severe complications nor perioperative death occurred in all 40 cases. 28 cases completed the total 6 cycles of adjuvant chemotherapy; and the chemotherapy was interrupted in the other 12 cases after 1-3 cycles due to severe reflux esophagitis which induced aglutition and could not be relieved after symptomatic and supportive treamnent in 8 cases ,and grade 3/4 thrombocytopenia which was not improved by decrement of chemotherapeutics and adjuvant treatments in 4 cases, and both the reflux esophagitis and thrombocytopenia came to be relieved gradually after chemotherapy discontinuation. CONCLUSION: FJI is a safe and feasible reconstructive method after total gastrectomy procedure for patients with advanced gastric carcinoma. As all patients received adjuvant chemotherapy with XELOX regimen , 70% patients showed good tolerance and accomplished the postoperative adjuvant chemotherapy wuth XELOX, while the other 30% patients were obliged to discontinue the postoperative adjuvant chemotherapy due to severe toxicity ,mainly severe reflux esophagitis and grade 3/4 thrombocytopenia.