胃癌合并肝硬化门静脉高压症的手术疗效评估

目的 评估胃癌合并肝硬化门静脉高压症(portal hypertension,PHT)的手术方式及其疗效.方法 回顾性分析60例胃癌合并PHT患者的临床资料,其中肝功能Child A级30例,Child B级30例;胃癌Ⅰ期、Ⅱ期和Ⅲ期分别为10例、38例和12例,分别行胃癌根治术或(和)脾切除+胃冠状静脉结扎术.结果 26例行胃癌根治手术或(和)脾切除术+胃冠状静脉结扎术都导致术后Child-Pugh分级的降低,发生率100%;34例只行胃癌根治术,未进行PHT外科处理,有7例出现Child-Pugh分级降低,发生率为20%,两者比较差异有统计学意义,P＜0.01.本组围手术期死亡率为3%,均为胃癌Ⅲ期合并Child-Pugh B级患者.对Ⅲ期胃癌合并Child B级若同时处理PHT,则患者的1年生存率极低.结论 胃癌合并PHT外科治疗的原则是限制性手术,以胃癌根治和切勿损伤肝功能为前提.重视围手术期处理,尤其是加强保肝治疗,更是手术成功的关键.

Management strategy for gastric cancer with liver cirrhotic portal hypertension

Objective To assess the concurrent management for portal hypertension (PHT) in gastric cancer patients. Methods Retrospective analysis was made on 60 cases of gastric cancer occurring on the background of cirrhotic PHT, of which 30 cases were of Child A grade, and 30 patients were Child B class. Ten cases were on gastric cancer stage Ⅰ , 38 cases on stage Ⅱ and 12 cases were on stage Ⅲ.Radical gastrectomy plus splenectomy and devascularization were performed in 26 cases, while radical gastrectomy only was done in 34 cases. Results Postoperative Child-Pugh degrading developed in 100% cases undergoing combined procedures; while in the 34 cases undergoing radical gastrectomy only,postoperative degradation from the preoperative Child-Pugh classification occurred in 7 cases ( 20% ), P ＜0. 001. In this series the peri-operative mortality was 3%, all were patients at stage Ⅲ gastric cancer combined with Child-Pugh class B. Conclusions The principle of treatment for gastric cancer with cirrhotic portal hypertension is restrictive surgery. The main purpose is to cure cancer and not to damage liver function.