胃癌诊疗的热点和问题

符涛　季加孚



胃癌诊疗的热点和问题

符涛季加孚

摘要我国是胃癌高发地区，发病率与死亡率在恶性肿瘤中均位居前列，受区域发展水平的制约，我国的胃癌诊治条件尚不能够完全满足众多病患的需求，面临着十分严峻的抗击胃癌形势。多学科、个体化、规范化治疗是胃癌诊治的发展趋势，目前有关胃癌的热点及争议有很多，胃癌诊治问题的解决有赖于循证医学研究的进一步发展。本文从胃癌临床分期、腹腔镜手术技术、早期胃癌的诊治、晚期胃癌转化治疗、食管胃结合部癌的治疗策略、快速康复外科、基础医学转化研究及胃癌临床试验等方面进行综述，系统地概括当前胃癌诊疗的热点和问题，希望能对广大同道起到一定的参考作用。

关键词胃癌诊疗热点与争议

The foci and problems in diagnosis and treatment of gastric cancer

Tao FU, Jiafu JI
Correspondence to: Jiafu JI; E-mail: jiafuj@hotmail.com
Department of Gastrointestinal Surgery, Beijing Cancer Hospital＆Institute, Peking University School of Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China

Abstract China has high prevalence of gastric cancer, with the morbidity and mortality leading the list of malignancy. The conditions of diagnosis and treatment of gastric cancer in China fail to meet the need of a large number of patients because of restriction in regional development. Therefore, we are facing a very serious situation of fighting against gastric cancer. Multidiscipline, individualization, and standardization are the development tendency of diagnosis and treatment of gastric cancer. Numerous topics about gastric cancer are currently controversial and solutions to these problems depend on the development of evidence-based medicine. This review summarized the recent progress in the clinical methods used for stomach cancer, laparoscopic surgical techniques, diagnosis and treatment of early gastric cancer, conversion therapy of advanced gastric cancer, therapeutic strategy of esophageal-gastric junction cancer, enhanced recovery after surgery, and translational research and clinical trials of gastric cancer. Moreover, the foci and problems of the diagnosis and treatment of gastric cancer were discussed to provide reference for further studies.

Keywords:gastric cancer, diagnosis and treatment, problems and controversial topics

根据世界卫生组织的最新报道，胃癌的发病率居于恶性肿瘤全球发病率的第5位，其死亡率更是高居第3位，仅次于肺癌与肝癌。中国每年胃癌新发病例占世界新发病例40%以上，相比欧美地区较低的胃癌发病率及日韩地区较高的早期胃癌诊断率，我国面临着十分严峻的抗击胃癌形势。在我国，超过80%的新发病例一经诊断已达进展期，而我国各地胃癌诊疗水平参差不齐，难以达到统一的规范化标准治疗，因此，如何提高进展期胃癌治疗的疗效并保证治疗的安全性将是我们未来相当长一段时间内面临的艰巨任务。笔者结合国内外最新文献、学术会议及自身经验，对胃癌诊疗的热点和问题进行了思考。……