胃癌肝转移患者的手术治疗及预后分析

目的探讨胃癌肝转移患者手术治疗的指征和效果。方法回顾性分析我院1995年9月至2002年5月间经手术治疗的43例胃癌肝转移患者的临床资料。结果全组肝转移程度与患者性别、年龄、肿瘤侵犯深度、分化程度及有无淋巴结转移无相关关系(P>0.05)。异时性肝转移行肝切除4例,中位生存时间为35.0个月,预后明显优于同时性肝转移肝切除患者(中位生存时间10.0个月)(P=0.0233)。同时性肝转移组中,单纯胃切除32例,中位生存时间6.0个月;胃加肝切除7例,中位生存时间10.0个月,两组差异无统计学意义(P=0.2799)。不同肝转移程度姑息性胃切除术后生存时间比较,H1、H2和H33组分别为7.5、6.0和4.0个月,差异具有统计学意义(P=0.0007)。结论异时性胃癌肝转移患者肝切除术后预后良好,应争取积极手术切除;胃癌肝转移患者同期行胃加肝切除生存率未见明显改善;H3肝转移患者姑息性胃切除预后不佳。

Prognostic analysis of surgical resection for patients with liver metastases from gastric cancer

OBJECTIVE: To assess the indication and efficacy of surgical treatment for patients with hepatic metastases from gastric cancer. METHODS: Clinical data of 43 patients with hepatic metastases from gastric cancer undergoing surgery from September 1995 to May 2002 were analyzed retrospectively. RESULTS: No relationships were found between the number of hepatic metastases and patient's gender, age, tumor invasion depth, lymphotic node metastases and differentiation P> 0.05. All of 43 patients underwent surgery. Four cases undergoing hepatic resection for metachronous hepatic metastases had a higher survival rate than those who had curative resections for synchronous hepatic metastases (median survival 35 months vs. 10 months) (P=0.0233). 39 patients had synchronous hepatic metastases, of whom 32 patients received gastric resection only and 7 patients received both gastric and hepatic resections, there was significant difference of median survival between synchronous group and metachronous group(median survival 6.0 vs. median survival 10.0 months)(P=0.2799). There was significant difference of the postoperative survival rate among H (1) (7.5 months), H (2) (6 months) and H (3) (4 months) in the patients with palliative gastric resections (P=0.0007). CONCLUSION: Hepatic resection for metachronous hepatic metastases from gastric cancer has a better prognosis. Resections of gastric and hepatic lesions at the same time may not benefit the patients with liver metastases from gastric cancer. H(3) is not feasible for palliative gastric resections.