胃癌合并肝硬化病人D1和D2淋巴结清扫术后并发症对比分析

Comparison of complications between D1 and D2 operative methods in gastric cancer with liver cirrhosis

目的分析比较胃癌合并肝硬化病人接受胃癌根治术D1和D2淋巴结清扫的术后并发症情况。方法回顾性分析1994年3月至2006年3月大连医科大学附属第一医院诊治54例胃癌合并肝硬化病人接受胃癌根治术的临床资料,比较D1和D2淋巴结清扫的临床疗效。结果胃癌合并肝硬化病人接受胃癌根治术的1、3、5年存活率分别为77.8%、44.4%、33.3%。行D1淋巴结清扫术(D1组)1、3、5年存活率为81.3%、37.5%、25.0%,行D2淋巴结清扫术(D2组)为76.3%、47.4%、36.8%(P>0.05),54例病人中位生存时间32个月,D1组为23个月,D2组为34个月。D1组和D2组肝功能Child-Pugh分级A级病人并发症发生率差异无统计学意义;Child-Pugh分级B、C级的病人中,D2组肝肾功能障碍发生率明显高于D1组(P<0.05)。结论胃癌合并肝硬化病人D2组较D1组的存活率差异无统计学意义。肝功能Child-Pugh分级A级病人行D2淋巴结清扫并不增加并发症发生率,Child-Pugh分级B、C级的病人应慎行D2淋巴结清扫。

Objective To investigate complication after D1 and D2 lymph node dissection for gastric cancer with liver cirrhosis. Methods The clinical data of 54 cases of gastric caner with liver cirrhosis received radical gastrectomy between March 1994 and March 2006 at the First Affiliated Hospital of Dalian Medical University were analyzed retrospectively. The therapeutic efficacy of D1 and D2 lymph node dissection was compared. Results The 1-, 3- and 5- year survival rates of the 54 cases were 77.8%, 44.4% and 33.3%; of which those of D1 were 81.3%, 37.5% and 25.0% and those of D2 were 76.3%, 47.4% and 36.8% （P〉0.05）. Median survival time of 54 cases was 32 months; of which that of D1 was 23 months and that of D2 was 34 months. There was no significant difference in complication incidences between D1 and D2 in Child-Pugh grade A. （P〉0.05）. The incidence of hepatonepheric functional disturbance in D2 in Child-Pugh grade B and C was higher than that of D1 （P〈0.05）. Conclusion There is no significant difference in survival rates of gastric cancer with liver cirrhosis between D1 and D2. D2 lymph node dissection does not increase the risk of complications in Child-Pugh grade A . D2 lymph node dissection should be perform cautiously for gastric cancer with liver cirrhosis in Child-Pugh grade B or C.