胃癌合并肝硬化门静脉高压症的外科治疗

目的探讨胃癌合并肝硬化门静脉高压症的外科治疗策略以及影响预后的因素。方法回顾性分析收治的31例胃癌合并肝硬化门静脉高压症患者的临床资料,筛选影响患者术后并发症法发生及预后的因素。结果31例患者中Child-PughA级15例,B级11例,C级5例。行单纯远端胃根治性切除术9例,单纯上半胃根治性切除术5例,远端胃根治性切除＋脾切除2例,远端胃根治性切除＋脾切除＋贲门周围血管离断术5例,上半胃根治性切除＋脾切除7例,全胃切除＋脾切除1例,姑息性肿瘤切除＋脾切除＋贲门周围血管离断术1例,姑息性肿瘤切除1例。术后19例出现并发症,其中腹水17例。术后死亡6例。18例接受D2淋巴结清扫的患者中12例出现并发症,13例D0或D1清扫的患者5例出现并发症。出院患者术后生存期2月～39月,中位生存期15月,4例尚存活。结论为胃癌合并肝硬化门静脉高压症患者施行手术,严格把握手术适应证和选择合理术式是关键。胃癌手术应遵循缩小手术的原则,术前肝功能状况、术前有无腹水和肿瘤分期是术后生存期的决定性因素。

Surgery for gastric cancer with cirrhosis portal hypertension

Objective To discuss the surgical procedures and prognostic factors for gastric carcinoma associated with liver cirrhosis and portal hypertension.MethodsThirty-one patients with gastric carcinoma associated with liver cirrhosis and portal hypertension were treated surgically at our hospital from October 1999 to December 2008. The clinical data of these patients were retrospectively analyzed.Results Of the patients,15 had the tumor of Child-Pugh score A,11 B and 5 C. Distal subtotal radical gastrectomy was performed in 9 patients, proximal subtotal radical gastrectomy in 5, distal subtotal gastrectomy+splenectomy in 2, distal subtotal gastrectomy+splenectomy+ devascularization in 5, proximal subtotal gastrectomy+spenectomy in 7, total gastrctomy+splenectomy in 1, palliative tumor excision+splenectomy+ devascularization in 1, and palliative excision in 1. Complications were seen in 19 patients, of whom 17 developed ascites. Six patients died at the hospital after surgery. 12/18 patients who had been undergone D2 lymph node dissection developed postoperative ascites, whereas 5/13 patients with D0 or D1 lymph node dissection had ascites. Postoperative survival time ranged from 2 to 39 months, the median survival time was 15 months, and 4 patients were still alive.Conclusions The key to successful surgical treatment of a patient with gastric carcinoma associated with liver cirrhosis and portal hypertension is the access of strictly ruled indication and a reasonable surgical procedure. Minor procedure is advocated in gastric surgery. Preoperative hepatic function, preoperative ascites and tumor stage are factors affecting postoperative survival.