根治性近端胃次全切或全胃切除加脾切除术在胃癌合并肝硬化门脉高压症中的应用

Application of the Radical Proximal Subtotal Gastrectomy or Total Gatrectomy and Splenectomy in Gastric Cancer with Portal Hypertension

目的:探讨根治性近端胃次全切或全胃切+脾切除术在胃癌合并肝硬化门脉高压症患者(childA级)外科治疗中的作用。方法:回顾性分析我院10年间运用根治性近端胃次全切或全胃切+脾切除术治疗8例肝功能child A级胃癌合并肝硬化门脉高压症患者的临床资料。术前充分评估患者的肝功能、凝血机制、营养状态后积极改善,预测肿瘤切除的可能性,行根治性近端胃次全切除+脾切除3例,全胃切+脾切除术5例。结果:8例患者术后均出现不同程度的腹水,创面渗血2例,膈下感染1例。均经积极治疗后恢复,无围手术期间死亡。结论:根治性近端胃次全切或全胃切除+脾切除术应用于肝功能childA级胃癌合并肝硬化门脉高压症患者是合理的选择。

Objective：To evaluate the effect of the radical proximal subtotal gastrectomy or total gatrectomy ＋splenectomy in treating gastric cancer with portal hypertension. Method：Clinical datas of 8 patients（child A）of the radical proximal subtotal gastrectomy or total gatrectomy ＋splenectomy in treating gastric cancer with portal hypertension who were surgically treated in our hospital during the last 10 years were studied retrospectively.Preoperatively,a detailed examination,and improvement of their liver function,prothrombin time and nutritional status were aggressively made,and the possibility of tumor removal was estimated.Three patients underwent radical proximal subtotal gasterectomy and splenectomy,and five patients urderwent total gastrectomy and splenectomy. Result：All 8 patients had varying degrees of ascites.Wound oozing in 2 cases,subdiaphrogmatic abscess 1 case.All patients recovered after treatment.There were no perioperative deaths in this series. Conclusion：Radical proximal subtotal gastrectomy or total gatrectomy ＋splenectomy in treating gastric cancer with portal hypertension is a reasonable choice.