探讨腹腔镜探查联合腹腔脱落细胞学检测在Ⅳb期胃癌（伴有单一不可切除因素的远处转移晚期胃癌）患者腹腔转移精准分期及临床诊治中的临床意义。

回顾性分析2015年10月至2018年10月河北医科大学第四医院连续收治的618例胃癌患者临床资料，患者临床影像学分期为Ⅳb期且随访资料完整，按照治疗方案的不同分成两组：直接化疗组（直接行全身性化疗）和腹腔镜探查组（腹腔镜探查联合腹腔脱落细胞学检测，根据探查结果决定治疗方案），比较两组患者治疗情况及预后情况。

直接化疗组285例，2年总生存率为46.67%。腹腔镜探查组333例，2年总生存率为59.46%，其中P₀CY₀ 185例（55.56%），P₀CY₁ 85例（25.53%），P₁CY₁ 63例（18.92%），2年生存率分别68.65%、57.65%、34.92%，差异有统计学意义（P<0.001）。两组2年总生存率比较差异有统计学意义（P<0.001），其中腹腔镜探查组发生肝转移、肺转移、卵巢转移、16a2/b1组淋巴结转移及左锁骨上淋巴结转移患者的2年生存率明显优于直接化疗组中相同转移部位患者（均P<0.05）。

腹腔镜探查联合腹腔脱落细胞学检测有助于发现腹腔内隐蔽性转移，同时还能为合并腹腔转移的Ⅳb期胃癌患者提供一种新的诊疗模式即腹腔镜探查确诊-腹腔热灌注化疗，显著提高临床决策及诊治水平。

To explore the clinical significance of laparoscopy combined with peritoneal exfoliative cytology in the precise staging and clinical diagnosis and treatment of patients with stage Ⅳb gastric cancer (advanced gastric cancer with distant metastasis with a single unresectable factor).

The clinical data of 618 consecutive patients with gastric cancer admitted to the Fourth Hospital of Hebei Medical University from October 2015 to October 2018 were retrospectively analyzed, the clinical imaging stage of the patients was stage Ⅳb and the follow-up data were complete. They were divided into two groups according to different treatment plans: direct chemotherapy group (direct systemic chemotherapy) and laparoscopy group (laparoscopy combined with abdominal exfoliation cytology, the treatment plan was determined according to the results of the exploration), the treatment and prognosis between the two groups were compared.

There were 285 cases in the direct chemotherapy group, and the 2-year overall survival rate was 46.67%. In the laparoscopy group, there were 333 cases with 2-year overall survival rate of 59.46%, including 185 cases (55.56%) of P₀CY₀, 85 cases (25.53%) of P₀CY₁, 63 cases (18.92%) of P₁CY₁, and the 2-year survival rates were 68.65%, 57.65% and 34.92% respectively (P<0.001). There was a statistically significant difference in the 2-year overall survival rate between the two groups (P<0.001). The 2-year survival rate of patients with liver metastasis, lung metastasis, ovarian metastasis, lymph node metastasis and left supraclavicular lymph node metastasis in the laparoscopy group was significantly better than that in the direct chemotherapy group (P<0.05).

Laparoscopy combined with abdominal exfoliative cytology helps to discover hidden metastasis in the abdominal cavity, meanwhile it can provide a new diagnosis and treatment mode, laparoscopy confirmed diagnosis-hyperthermic intraperitoneal chemotherapy, for the treatment of patients with stage Ⅳb gastric cancer with abdominal metastasis, which will significantly improve clinical decision-making.