肝硬化胃癌患者术后并发症危险因素在手术根治度选择中的价值

【目的】探讨胃癌合并肝硬化患者术后并发症的影响因素，分析合理的手术方式。【方法】回顾性分析2010年6月-2013年6月我科69例胃癌并肝硬化患者的病例资料，记录术后并发症发生率，单因素及Logistic多因素分析年龄、性别、淋巴结清扫范围、肝功能分级等11个因素对术后并发症的影响。【结果】37例（53．6％）胃癌合并肝硬化患者术后m现并发症，以腹水（27．5％）最多见。单因素分析手术根治度、脾切除、Child—Pugh分级、有无门静脉高压、有无基础疾病与术后并发症有关（P〈0．05），多因素Logistic回归结果提示Child—PughB或C、脾切除、D2淋巴清扫、术前有门静脉高压、合并基础疾病是术后出现并发症的独立危险因素（P〈0．05）。【结论】胃癌合并肝硬化术前应改善肝功能和门脉高压症，不应追求淋巴结清扫和联合脏器切除，减低术后并发症风险。

Logistic analysis of relevant factors for postoperative complications in gastric carcinoma combined with liver cirrhosis and its value for the extent of gastrectomy

Objective ]To explore the relevant factors for postoperative complications in gastric carcinoma combined with liver cirrhosis and its value for the extent of gastrectomy. Method ] The total of 69 patients with gastric cancer associated with liver cirrhosis between June 2010 and June 2013 were analyzed retrospectively.Eleven clinical variables such as age,sex, Borrmann type, Child-pugh score grade were selected for univariate analysis,and multiplevariate Logistic regression analysis was conducted concerning signifiean! variables. Results] 37 cases（53.6%） had postoperative complications,and the ascites（27.5%） were the most common type. Univariate analysis showed that the extent of lymphadenectomy, resection of spleen,Child-pugh score grade,portal hypertension,basic disease were relevant with postoperative complications. Logistic regression analysis of these variables revealed that B or C grade of Child-pugh score, resection of spleen, D2 lymphadenectomy,portal hypertension and combined basic disease were independent risk factors. Conclusion ] The gastrectomy in gastric carcinoma combined with liver cirrhosis should not pursue the lymphadenectomy and the resection of adjacent organs. Preoperative improvement of liver function to degrade Child-pugh score and portal hypertension could reduce the risk of postoperative complications.