胃癌合并肝硬化手术后远期生存率的影响因素分析

目的：评价胃癌合并肝硬化患者手术后的远期生存率及其影响因素。方法回顾性分析41例合并肝硬化胃癌患者的术后随访资料，分析远期生存率的影响因素。结果本组患者围手术期无死亡病例，Cox回归分析发现 TNM分期是 Child A 级患者远期生存的危险因素，而MELD评分是Child B级患者远期生存的危险因素。结论代偿性肝硬化患者的远期生存主要受肿瘤复发影响，而失代偿肝硬化患者的远期预后主要决定于肝功能状态而非肿瘤手术方式。

Analysis of influencing factors for long-term survival after surgery for gastric carcinoma patients with liver cirrhosis

Objective To explore the clinical value of percutaneous transhepatic gallbladderdrainage（PTGBD）for elderly critically ill patients with acute cholecystitis.Methods The clinical data of77 cases of elderly acute cholecystitis with severe basic diseases from October 2011 to October 2013 wereretrospectively analyzed,including 40 cases of emergent PTGBD and 37 cases of gallbladder excision or fis tula.Results PTGBD was successfully performed in the 40 cases.Abdominal pain,fever and other symp toms were obviously alleviated or disappeared within 1 ~3 d and the number of white blood cells went backto normal within 5 ~7 d.One case had hemocholecyst and got cured after clipping catheter.No peritonitisor bile leakage occurred but two cases with systemic complications died.Nine cases received selective gall bladder surgery and got cured.In the 37 patients with surgery,10 patients had systemic complications and6 cases of them died.There were significant differences in postoperative complication rate（0.05 vs 0.27）and mortality rate（0.05 vs 0.16）between the surgery group and PTGBD group（P 〈0.05）.Conclusion PTGBD is a safe and effective emergency measure for elderly critically ill patients with acute cholecystitis.