《日本胃癌治疗指南2021（第6版）》解读及瑞金实践

doi:10.16139/j.1007-9610.2023.04.010

摘要/Abstract

摘要：

《日本胃癌治疗指南》一直是日本乃至全球胃癌治疗领域的重要指导性文件，临床意义重大。2023年1月发表的英文版《日本胃癌治疗指南2021（第6版）》由两部分组成,第一部分为诊疗方法，包括手术、内镜切除、化疗、随访等；第二部分为临床问题，包括对临床热点问题的建议和解释。本文将对该版指南进行中文解读，并对我院胃癌诊治的临床实践作简要介绍。

关键词: 胃癌, 日本, 指南解读

Abstract:

“Japanese Gastric Cancer Treatment Guidelines” have been important guidelines for the treatment of gastric cancer in Japan and worldwide. The English version “Japanese Gastric Cancer Treatment Guidelines 2021 (6th Edition)” published in January 2023 consists of two parts. The first part includes diagnostic and treatment methods, such as surgery, endoscopic resection, chemotherapy, follow-up. The second part addresses clinical issues, including recommendations and explanations for clinical hot topics. This article will provide a Chinese interpretation of the guidelines and briefly introduce our hospital's clinical practice in the diagnosis and treatment of gastric cancer.

Key words: Gastric cancer, Japan, Guide interpretation

中图分类号:

R735.2

严超, 陆晟, 燕敏, 朱正纲. 《日本胃癌治疗指南2021（第6版）》解读及瑞金实践[J]. 外科理论与实践, 2023, 28(04): 326-354.

YAN Chao, LU Sheng, YAN Min, ZHU Zhenggang. Chinese interpretation of Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition) and Ruijin clinical practice[J]. Journal of Surgery Concepts & Practice, 2023, 28(04): 326-354.

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浸润深度	溃疡		分化型		未分化型
M	UL0	肿瘤长径	≤2 cm	>2 cm	≤2 cm	>2 cm
		淋巴结转移发生率	0 (0/437)	0 (0/493)	0 (0/310)	2.8% (6/214)
		95%CI	0~0.7%	0~0.6%	0~0.96%	1.0%~6.0%
	UL1	肿瘤长径	≤3 cm	>3 cm	≤2 cm	>2 cm
		淋巴结转移发生率	0 (0/488)	3.0% (7/230)	3.0% (8/271)	5.9% (44/743)
		95%CI	0~0.6%	0.3%~9.0%	1.2%~5.7%	4.3%~7.9%
SM1		肿瘤长径	≤3 cm	>3 cm	任意长径
		淋巴结转移发生率	0 (0/145)	2.6% (2/78)	10.6% (9/85)
		95%CI	0~2.6%	0.3%~9.0%	5.0%~19.2%

临床措施	临床路径的日期
拔除鼻胃管	手术当天或术后第1天
开始进食流质	术后第1天起
开始进食半流质	术后第2~4天
预防性输注抗生素	手术当天
拔除硬膜外导管	术后第3天或之前
拔除导尿管	术后第3天或之前
静脉补液	直至术后5~7天
拔除腹腔引流管	术后第5天或之前
出院	术后第8~14天

术后时间	年			1	1.5	2	2.5	3	4	5
术后时间	月	1	6	12
体检、PS评分、体重		○	○	○	○	○	○	○	○	○
血液检查（肿瘤标志物等）		○	○	○	○	○	○	○	○	○
CT和（或）超声检查				○				○	○	○
内镜检查				○				○		○

术后时间	年					1				2	2.5	3	3.5	4	4.5	5
术后时间	月	1	3	6	9	12	15	18	21	24
体检、PS评分、体重		○	○	○	○	○	○	○	○	○	○	○	○	○	○	○
血液检查（肿瘤标志物等）		○	○	○	○	○	○	○	○	○	○	○	○	○	○	○
CT和（或）超声检查				○		○		○		○	○	○		○		○
内镜检查						○		○		○		○				○

证据级别	定义
A（强）	效果的期望值有很强的可靠性
B（中）	效果的期望值有中等强度的可靠性
C（弱）	效果的期望值可靠性有限
D（很弱）	效果的期望值几乎无可靠性