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同时性胃癌肝转移行同期胃联合肝脏切除术的安全性分析
引用本文:杨新伟.同时性胃癌肝转移行同期胃联合肝脏切除术的安全性分析[J].中华医学杂志(英文版),2012,125(5).
作者姓名:杨新伟
作者单位:第二军医大学附属东方肝胆外科医院
摘    要:摘要 目的:很多研究已证实:对于孤立性、异时性胃癌肝转移患者可以从肝脏切除术中获益。然而,有关同时性胃癌肝转移患者的手术指征和手术疗效仍存在一定的争议。本研究的目的:评估同时性胃癌肝转移行同期胃联合肝脏手术的安全性,从而明确哪类患者可能从中获益。 方法 在2005年1月到2008年6月期间,共有13例同时性胃癌肝转移患者行同期胃联合肝脏手术。对13例患者的临床病理特点和手术情况进行回顾性分析。分析患者因素、肿瘤特点(胃癌和转移性肝癌)、手术情况对生存率的影响。 结果 围术期未见死亡病例,2例患者术后出现并发症。术后6个月、1年和2年的实际生存率分别为76.9%、38.5%和30.8%。在末次随访期间,2例患者术后2年未见肿瘤复发。在单因素分析中,肝转移灶的肝叶分布和数量是影响生存率的独立危险因素。原发灶(胃癌)的相关因素对生存率的影响无显著性统计学意义。 结论 严格的筛选后的同时性胃癌肝转移患者行同期胃联合肝脏手术可以获得满意的生存率。肝转移灶的数目是影响预后的显著性因素。

关 键 词:同时性肝转移  胃癌  手术  预后

Synchronous hepatic metastases from gastric carcinoma: A simultaneously combined resection
Institution:Eastern Hepatobiliary Surgery Hospital
Abstract:Abstract Objective Many studies have reported the benefit of hepatic resection for solitary and metachronous metastases from gastic cancer. However, indications and surgical results for synchronous hepatic metastases from gastric carcinoma have not been clearly defined. To assess the benefits and limits of simultaneously combined resection of both primary gastric cancer and synchronous hepatic metastases, as well as to identify patients with a better probability of survival. Methods Between January 2005 and June 2008, 13 patients with synchronous hepatic metastases underwent simultaneously combined resection. The clinicopathologic features and the surgical results of the 13 patients were retrospectively analyzed. Patient, tumour (primary and metastatic carcinoma) and operative paranetery were analyzed for their influence on survival. Results No patient died and two patients (15.4%) developed complications during perioperative course. The actuarial 6-month, 1-year, and 2-year survival rates after hepatic resection were, respectively, 76.9%, 38.5%, and 30.8%, and two patients survived for more than 2 years after surgery without any signs of recurrences until latest follow. In the analysis, hepatic tumor distribution and number of hepatic metastases were significant prognostic factors that influenced survival. Factors associated with the primary lesion were not significant prognostic factors. Conclusions Satisfactoried survival can be achieved by simulatneously combined resection of both primary gastric cancer and synchronous hepatic metastases in strictly selected patients. The number of hepatic metastases is an significant prognostic determinants in defining a poor clinical outcome.
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