胃癌合并门脉高压症的外科治疗

Surgical Treatment of Gastric Cancer with Portal Hypertension

目的:探讨胃癌合并肝硬化门脉高压症患者的手术方式、围手术期处理方法及术后并发症发生的危险因素。方法:17例胃癌合并肝硬化患者行根治性近端胃次全切除术、脾切除、贲门周围血管离断术4例;全胃切除、脾切除、贲门周围血管离断术5例;根治性远端胃次全切除术、脾切除、贲门周围曲张血管缝扎术3例;根治性远端胃次全切除、脾脏切除、贲门周围血管离断术2例;根治性远端胃次全切除、脾切除术2例;姑息性远端胃大部切除术1例。结果:17例术后有不同程度的腹水,早期肝昏迷1例,创面渗血3例,腹腔脓肿1例,切口感染2例,均经积极治疗后恢复。结论:胃癌合并肝硬化手术后并发症发生率高,手术风险大,手术方式须根据肝硬化程度以及胃癌的部位等采用"个体化"处理原则。

Objective To evaluate the surgical methods for treating patients with gastric cancer and liver cirrhosis, the managements in perioperative periods, and risk factors relating with complications. Methods Among 17 cases, radical proximal subtotal gastrectomy ＋ splenectomy pericardial devascularization were used in 4 cases, total gastrectomy ＋ splenectomy pericardial devascularization in 5 cases, radical distal subtotal gastrectomy ＋ splenectomy pericardial resection surgery varicose vascular suturing in 3 cases, radical distal subtotal gastrectomy ＋ spleectomy ＋ pericardial devascularization in 2 cases, radical resection of distal subtotal gastrectomy ＋ splenectomy in 2 cases, and palliative distal subtotal gastrectomy in 1 case. The perioperative conditions of all patients were recorded and analyzed in accord with different procedures. Results All 17 patients had varying degrees of ascites. Other complications included early hepatic coma 1 case. Wound oozing 3 cases, abdominal abscess 1 case, incision infection 2 cases. All patients recovered after treatment. No one died during peri-operative period. Conclusion Patients with gastric cancer and liver chrrhosis have high incidence of complications after operation, having any surgery should be of high-risk. Individualized treatment principle have to be used according to the liver function as well as the site of gastric cancer.