胃肠恶性肿瘤伴肝硬化门静脉高压症的外科治疗

目的总结肝硬化门静脉高压症合并胃肠肿瘤患者围手术期处理经验。方法对2000年1月至2005年7月收治的23例(17例胃肿瘤及6例结肠肿瘤)合并肝硬化门静脉高压症行手术治疗的胃肠肿瘤患者资料进行回顾性分析研究。结果本组23例患者,治愈17例,死亡6例,死因为MODS5例,急性肺栓塞1例,病死率为26.1%。死亡病例与肝功能分级有明显关系,ChildA级死亡1例(12.5%),B级死亡2例(22.2%),C级死亡3例(50%)。发生吻合口漏1例,胰尾血管出血1例,未发生残胃缺血。结论对合并有门静脉高压症的胃肠肿瘤患者,正确掌握其手术适应证和时机,加强围手术期处理,以降低病死率和并发症发生率。

Surgical management of gastrointestinal tumor with liver cirrhosis and portal hypertension

Objective To sum up the experience in the peri-operative management of gastrointestinal tumor with liver cirrhosis and portal hypertension. Methods A retrospective analysis was made in 23 cases with gastrointestinal tumor combined with liver cirrhosis and portal hypertension gastric tumor including 17 with gastric cancer and 6 with intestinal tumor admitted into our hospital from January 2000 to July 2005. Results Of all, 17 cases were cured but 6 died due to multiple organ dysfunction syndrome MODS (5 cases) and acute pulmonary embolism (1 case), with morbidity rate of 26.1%. Death was obviously correlated with liver function classification, ie, there was 1 death at Grade A (12.5%), 2 at Grade B (22.2%) and 3 at Grade C (50%). Leakage of stoma occurred in 1 case and bleeding of pancreatic tail vessel in 1, with no ischemia of residual stomach. Conclusions For cases with gastrointestinal tumor combined with liver cirrhosis and portal hypertension, we should emphasize on peri-operative management and master appropriate surgical indication to decrease mortality and incidence rate of complications.