胃癌合并肝硬化门脉高压症的诊治分析

Diagnosis and treatment of gastric cancinoma with portal hypertension: an analysis of 42 cases

目的探讨胃癌合并肝硬化门脉高压症的临床特征和治疗方法。方法回顾性分析2000年1月至2007年12月我院收治的42例胃癌合并肝硬化门脉高压症患者的临床资料,其中手术治疗30例。结果12例未行手术治疗者均在胃癌诊断后1年内死亡。手术患者无围手术期死亡,其中27例获得随访,随访时间3个月至8年,中位随访时间3年,1,3,5年生存率分别为74.1%(20/27)、44.5%(12/27)和22.2%(6/27),死亡原因:2例死于化疗后白细胞显著下降所致的严重感染和急性肝功能衰竭,1例死于上消化道大出血,其余患者死于胃癌复发和转移。结论胃癌合并门脉高压症患者手术并发症发生率高,手术方式需根据肝功能情况、上消化道出血史以及肿瘤的部位等采用"个体化"原则。加强围手术期处理和选择适当的辅助治疗有利于改善患者的预后。

Objective To explore the clinical features and treatment methods of gastric cancinoma with portal hypertension. Methods From January 2000 to December 2007, 42 patients with gastric cancinoma and portal hypertension were treated in our hospital and 30 of them underwent operations. The results were analyzed retrospectively. Results Twelve patients who had not undergone operations died in one year after gastric carcinoma was diagnosed. There was no perioperative death. Twenty-seven cases who received surgical treatment were followed up for 3 months to 8 years （ average time 3 years）. One-, 3- and 5-year survival rates in patients after operations were 74. 1% （20/27） ,44. 5 % （12/27）and 22. 2% （6/27）respectively. Two cases died of severe sepsis due to leukopenia and acute hepatic failure after chemotherapy, 1 died of massive bleeding from upper alimentary tract, other deaths were because of cancer recurrence and metastasis. Conclusion Patients with gastric cancer and portal hypertension are at a significant risk of developing postoperative complications. The surgical procedure should follow the principle of ＂ individualization＂ according to liver function, upper gastrointestinal bleeding history and the position of gastric carcinoma. Intensifying perioperative management and selecting proper adjuvant therapy are important to improve the prognosis.