Gastric carcinoma treats _'s treatment

Gastric carcinoma treats _'s treatment
[Treat ]
(1) It is to radically treat the only scheme of the early gastric carcinoma at present that surgery treats surgery and excises, cancer implement carry person who effect a radical cure far stomach time excised all to early the intersection of stomach and body, sinus portion, cancer implements the proximal stomach time is excised completely or the whole stomach is excised to the stomach bottom. Stomach of effecting a radical cure etc. time excise range of skill, treat the intersection of stomach and time, ulcer of disease excise skill all as extensive relatively far all, because cancerous swelling can soak coat of the stomach and companion's lymph node to shift, so need to do more excision the coat of the stomach, and excise the relevant blocks together of lymph node, generally need to include the following tissues: The stomach sinus cancer person needs to excise the majority of the duodenum ball, it is usually about 3c m long; 75- 80% of the coats of the stomach, including all small and curved and big and curved majority; Clean the lymph node, the concrete lymphocytic roped party that gastric carcinoma of different positions needs to clean can consult table 25-3 and Fig. 25-13. According to the excision range of the lymph node, the operation method is with R (effect a radical cure) Say: R 1 means the stomach is excised with N a group of lymph nodes are removed; R 2 means the stomach is excised and all removed with N 1, N 2 groups lymph node; R 3 means the stomach is excised and all removed with N 1, N 2, N 3 groups lymph node. The standard gastric carcinoma operation is usually a R 2 type, only soak normal position cancer of the mucomembranous floor and use a type of R to be safe and rational; Remove big omentum, form leaf, pancreas make membrane, little omentum and the intersection of stomach and the intersection of liver and ligament at the mesenterium sideways; Fundus of stomach cancer still needs to excise the spleen sometimes. Near side stomach should cut end from the intersection of tumour and the intersection of edge and more than 3c m, should make and cut the end to organize icy work to examine in the skill, persons who organize remaining of cancer expand and excise the range again immediately.
The whole stomach excise postoperative the intersection of reconstruction and a lot way ' Fig. 25-15) . The identical operation of oesophageal duodenum is relatively simple and convenient, but there is shortcoming of returning to flowing esophagitis complication. Oesophageal jejunum is identical (L a hey law) Employ most wide, and R ou x-Y type can prevent bile, pancreatic juice from return to, shed and prevent the emergence of esophagitis from totally while being identical, it is its advantage.

If gastric carcinoma is spread or soaked to oesophageal underpart, colon, liver, pancreas when and neighbouring internal organs has no distant place to shift directly, so long as physical power of patient fair and ability receive more extensive operation, maintain some internal organs given much trouble to excise generally. According to the amynologic view, the relevant antigen of tumour on tumour cell membrane, can bring out the organism and produce body fluid and cell immunoreaction, cell toxic lymphocyte and antigen of antibody but and tumour cell are worked and destroyed and eliminated tumour cells. When increasing in tumour, the relevant antigen of tumour in the blood is increasing constantly, until the humoral antibody inside is being combined and neutralizes, the antigenic receptor on too many free tumour antigen and cell toxic lymphocyte acts on and closes the receptor, make the intersection of tumour and cell exempt from, destroy, produce specific immunity inhibit, but the intensity and the intersection of organism and load in tumour that immunity inhibit from become positive correlation. The surgical purpose is body of excision tumour as many as possible, in order to the burden to tumour of lightening the organism, and remaining can make use of immune defence capability of the organism to eliminate in the tumour cells of internal small quantity, result of chemotherapy can also improve, this it is modern so-called operation that it excises itself to be can one the intersection of enhancement and immune view of measure too. In addition, the emergence that the condoning excision can reduce serious complications such as bleeding, punch, obstructing,etc., it is undoubtedly beneficial to the life lengthening the patient.
(2) There is the operation cure rate of gastric carcinoma of chemotherapy only 20- 40% , Relatively cause of later period because of accepting and curing the disease, in order to improve the curative effect of the operation, can adopt radical operation and chemotherapy composite treatment. To the condoning excision case, the postoperative chemotherapy that takes over a longer period even more; To the later period not performing the operation case, chemotherapy mainer treatment means. Except that intravenous to give medicine, have already had clinically at present the chemotherapy medicine has instilled the method in launching the abdominal cavitied, the latter can make the medicine in abdominal cavity's internal organs taller than the vein in density.
While determining the chemotherapy scheme on clinic, should consider first that organize factors such as type, position, disease one,etc. in pathology of tumour. Gastric carcinoma belong to more gland cancers, Chang Duo selects 5 - Fluorine urine pyrimidine (5 - F u) for use , mitomycin (M M C) , A is mould and plain (A D M) , the inferior nitre urea (M e-C C N U) of first ring Medicine. If belong to early gastric carcinoma and not have lymph node to shift, and is performed the operation the persons who excise completely, do not add chemotherapy; Gastric carcinoma adopts chemotherapy as the main fact in later period, or the auxiliary chemotherapy after an operation, generally need to last 11/2- 2 years, begin in postoperative 3- 4 week. Chemotherapy of gastric carcinoma adopt, unite scheme is efficient to reach 40%, curative effect of scheme best (5 - F u + A D M + M M C) with F A M among them more at present ,The total amount regards 5- F u 10g-M M C 40mg as a course of treatment; A D M dosage can't exceed 550mg altogether, decline history person, forbid intentionally, liver function hinder person who hurt A D M consumption reduced by half. Should examine liver renal function, electrocardiogram and leucocyte to count during using medicine, if the leucocyte is counted and lower than 3500 m m 3 and blood platelet to count the person who lower thans 70,000, should suspend medicines.
1. F A M scheme
( 1) 5 - Fu 500m g quiet note of the first day, once of every week later; Or 5 - Fu daily 500m g, uses together for 5 days, injects for 5 days repeatedly every 3 weeks later.
( 2) A D M quiet note 30- 50m g of the first day, repeats once every 3 weeks later.
( 3) M M C quiet note 4- 10m g of the first day, repeats once every 3 weeks later.
2. F M - F scheme
( 1) 5 - F u quiet note 500m g of every day, use together for 3- 5 days.
( 2) M M C quiet note 6- 10m g of the first day.
The above repeat 1 every 3 weeks, 4 times a course of treatment. Have a rest after the 1 month giving 5 - Fu one course of treatment only, have a rest 1 repeat the intersection of F M and scheme month, count in the 1 year finishing F M - the intersection of F and scheme.
3. F M e A scheme
( 1) 5 - Fu quiet note 500m g of every day, use together for 5 days, repeats for 5 days every 5 weeks.
( 2) 100- 150m g takes orally on M e-C C N U the first day, repeats once every 10 weeks.
( 3) A D M quiet note 50m g of the first day, repeats once every 5 weeks.
4. F M e M scheme
( 1) 5 - Fu quiet note 500m g of every day, use together for 5 days, spends 5 days repeatedly every 3 weeks; Or 2 times of quiet note of one week, regarded using 10g as a course of treatment from the second week.
( 2) M M C is the 1st quiet note 8- 10m g, repeats once every 3 weeks later, regards using 40m g as a course of treatment.
( 3) Oral 100- 150m g of M e C C N U the first day, repeats once every 6-8 weeks.
5. Mutter Fluorine pyridine (F T-207) 200mg, takes orally 3- 4 times in one day each time. Suitable for the slightly bad one of general situation.
(the annotations)
1. 5 - Fu (5 - Fluorine urine pyrimidine, fluorou raacil) 250mg is one. Add into 5% of the glucose saline 500m l and make the vein to instil, or add the physiological saline 20ml vein to inject slowly inside.
2. M e-C C N U (inferior nitre urea of first ring, semu s tine) Each 10mg, 50m g hold.
3. M M C (mitomycin, m itomy cin C) Each bottle of 2mg. Soluble in the physiological saline 40m l vein to inject slowly inside.
4. A D M (A is mould and plain, has another name called the fluff of hydroxyl mouldly and plainly, a d r i a m y c i n) Each bottle of 10mg. Add the vein into 5% of the glucose saline 500m l to instil.
5. Mutter Fluorine pyridine (F T - 207, ftoraf uru m) Each 50mg, 100m g hold, FT-207 is derivative of 5 - Fu, can substitute Fluorine urine pyrimidine. According to general principle, person who effect a radical cure stomach excise adopt more single the intersection of chemotherapy and medicine while being postoperative, consider adopting and uniting chemotherapy the case failed to radically treat or perform the operation.
(3) And immune treatment and chemotherapy of the immune treatment are used and is thought to lengthen the function of the life, the B C G is the most commonly used. It is generally with 5m g B C G (grow several about 2- 4* 108 funguses) Apply on the skin of wrist, then take pinpoint as and escort the mark. BC G can strengthen non- specific immunoreaction, O K - 32 has the same function.
(4) The intersection of endoscope and treatment to unable case to carry on surgery, can adopt the endoscope to carry on palliative treatment for relieve narrow, symptom of bleeding etc., low temperature if utilizing liquid nitrogen make, organize necrosis, N d - the intersection of Y A G and laser shine raised pathological change,etc..
(5) Radiate and shine to irradiate the second stop lymphocytic roped party in the skill in the skill, can improve survival rate for 5 years. 2Issues of the above-mentioned case add with shine in the skill, result its fine than simple operation.
(6) Gastric carcinoma monoclonal antibody bind with stomach cancer cell only, but or other tumour cells react with organize normally. Such as combine with anticancer drugs and some the intersection of cell and toxin, monoclonal antibody can blow get " the biological guided missile " Efficiency,it some without being wounded for function of cancer cell can last dozens of time to several hundred time, especially wound function bigger on the cancer cell spread after the operation, so can reduce the consumption against cancer medicine, reduce the side effect of the medicine, thus improve the result of chemotherapy. The treatment that gastric carcinoma recurs: Early gastric carcinoma recurs in order to see more with the lymph node, but gastric carcinoma in period of progress recurs for being most with the peritoneum. The excision rate performing the operation again in case of recuring is generally in 9. 7% - 25.5% , Among them the excising rate of persons who recur of part is highest. Average life cycle after excising again is July - December, so but consider to the limitation the operation is excised in the isolated recurring cooking stove. Generally adopt complex treatment such as the chemotherapy, immunity. The problem of the incomplete gastric carcinoma has taken place after the stomach has excised the skill completely time to already pay attention to recently. Incomplete gastric carcinoma divide into for cut reason recur cancer and incomplete the intersection of stomach and new born cancer, the latter mean because benign pathological change and gastric carcinoma make the intersection of stomach and times of more than 10 years excise all, what take place sends cancer originally on the incomplete stomach. Incomplete the intersection of stomach and new born excision rate of cancer than recur cancer as being high, so should strive for the surgery treatment far.


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