!胃癌()

Dr. Zhang Jian,Clinical Roundsin General Surgery,Gastric carcinoma,Although its incidence in developed countries has declined, gastric cancer remains one of the most common human malignancies.,background,Today, we will reviews the modern approach to gastric cancer using the treatment guidelines published by UICC and JGCA.,GL aim to provide a standard indication for doctors to select the proper treatments of gastric cancer according to the clinical stages of patients.,Purpose of Guideline,Kernel of the Guideline,TNM staging,Stage-oriented treatment,Divisions of the stomach,Basic knowledge about Gastric carcinoma,The stomach is reflected cephalad,Blood supply to the stomach and duodenum,Tumor Location,Gross classifications,Early gastric carcinoma： defined as a primary lesion confined to the mucosa and submucosal layer with or without lymph mode metastasis. D 10mm is named little gastric cancer，DN，resected lymphonodes beyond metastatic lymphonodes；no cancer cells can be fund within 1cm of cutting border; a radical operation with good effect and high radical degree,definition of radical degree,Band B：D=N，or cancer cell can be found within 1cm of cutting border; radical operation，but band A is much better than it in that of radical degree and effect Band C：resection of lesion and partial metastatic focus only; remain of cancer cell ; non-radical operation,4 way of gastrectomy operation 1）partial gastrectomy 2）proximal subtotal gastrectomy 3）extensive radical operation of gastric cancer: radical subtotal gasrectomy or total gasrectomy include body and tail of pancrese、spleen 4）compound organs resection refers to resection with liver or transcolon etc 5）mini-trauma operation of gastric carcinoma in recent years,Surgical treatment,ApproachesIntraluminal endoscopyLaparoscopyLaparotomyThoraco-laparolomyOthersOperative proceduresMucosectomyWedge resectionSegmental resectionProximal gastrectomyPylorus preserving gastrectomyDistal gastrectomyTotal gastrectomy,Other resectionBypass without resectionExploratory laparotomyGastrostomy or other stoma fomationOther palliative operationsCombined resection,Symptoms of fatigue, dyspepsia, light weight loss or anemia in patients over 40 years require diligent examination to rule out gastric cancer.Patients with precursors of gastric cancer (adenomatous ployps, achlorydria, atrophic gastritis) require routine follow-up and treatment.Routine and combined apply of upper gastrointestinal x-ray, gastroscopy and biopsy in every patients who are suspected to have gastric cancer.,DIAGNOSIS,An example of subtotal gastrectomy and adequate lymphadenectomy.Nu