外科治疗胃癌肝转移疗效分析

目的探讨外科治疗胃癌肝转移的方法与疗效。方法1996年1月至2003年12月间行外科治疗的胃癌肝转移患者25例，17例为同时性肝转移，8例为术后发现的异时性肝转移。其中单转移灶15例，多转移灶10例。行不规则肝切除16例，左外叶切除4例，左叶切除3例，右叶切除2例，术后行肝动脉灌注化疗9例，肝动脉化疗栓塞16例。结果1例同时性肝切除患者术后死于肺部感染、成人呼吸窘迫综合征，余24例均获随访，中位时间25(7—60)个月。胃癌肝转移灶切除后1、3年生存率为68．5％和29．8％，原发癌浸润表浅、淋巴结转移少、单转移灶、异时性转移及转移灶有包膜是影响生存率的有利因素。结论同时及异时性胃癌肝转移可经外科手术切除肝转移灶，但应注意手术指征的把握。

Analysis of Surgical Treatment for Hepatic Metastasis from Gastric Cancer

Objective To investigate the effect of surgical treatment on hepatic metastasis from gastric cancer. Method 25 cases of hepatic metastasis from gastric cancer underwent surgical treatment from January 1996 to December 2003, including synchronous metastasis in 17 cases, metachronous metastasis in 8 cases. Metastases were solitary in 15 cases, multiple in 10 cases. Resection included irregular hepatectomy in 16 cases, left lateral lobectomy in 4 cases, left lobectomy in 3 cases, right lobectomy in 2 cases. Adjuvant therapy included postoperative hepatic arterial perfusion and chemotherapy in 9 cases, hepatic chemotherapy and embolization in 16 cases. Result 24 cases were followed up with 7 to 60 months (mean 25 months) except 1 case died of adult respiratory distress syndrome after hepatectomy. The 1- and 3-year survival rate was 68.5% and 29.8%, respectively. Less tumor infiltration, fewer lymphatic metastasis, solitary metastasis, metachronous metastasis, and well-capsule metastasis were the factors which positively correlated with a favorable survival. Conclusions Synchronous and metachronous metastasis from gastric cancer is amenable to resection, prognosis can be improved when the indication is strictly determined.