胃癌术后复发致梗阻性黄疸的挽救治疗

Salvage therapy for postoperative obstruction jaundice of gastric cancer

目的:总结胃癌术后复发引起的梗阻性黄疸的治疗。方法:回顾性分析2001-2010年我院收治的48例因胃癌术后复发所致梗阻性黄疸的资料。男性31例,女性17例。根治性切除术后42例,姑息性切除术后6例。黄疸发生于术后6个月以内、6-12个月(包括12个月)、13-24个月(包括24个月)、25个月及以上者分别为5例、14例、17例、12例。外科手术治疗12例,其中胆管空肠吻合4例,T管引流8例;经内镜放置胆道内支架7例;PTCD 17例;药物减黄治疗12例。34例经减黄治疗后行放、化疗综合治疗。结果:12例手术治疗者,2周内黄疸完全消退。7例经内镜置入内支架者,4周内黄疸完全消退率为85.7%。17例成功行PTCD患者4周内黄疸完全消退率为58.8%。12例黄疸较轻者药物治疗9例有效。全组患者中位生存期为7.5月,1年生存率为39.9%。结论:胃癌术后复发引起的梗阻性黄疸者愈后不佳;极积有效的减黄治疗可改善患者的生活质量,微创减黄可作为首选方法;对一般状态较好者,减黄后进行放、化疗综合治疗,有可能延长患者的生存期。

Objective： To summarize the treatment experience of obstructive jaundice in patients of recurrence gastric carcinoma. Methods：Total of 48 patients admitted from 2001 to 2010 with extrahepatie biliary obstruction caused by recurrence gastric cancer were retrospectively analyzed,31 of these cases were male and 17 were female, for which 42 cases underwent radical surgery and 6 cases palliative surgery in previous surgery. The jaundice emerged within 6 months,6 - 12 months,12 -24 months and more than 24 months in 5 cases,14 cases,17 cases and 12 cases respect from previous gastretomy. 12 patients underwent surgery procedures including choledochojejunostomy in 4 cases and insertion of T tube in 8 cases. 7 patients underwent endoscopic insertion of stent and 17 patients received biliary decompression by percutaneous transhepatic biliary drainage. For another 12 patients, they only received medicine treatment. Chemotherapy and/or radiotherapy were carried out in 34 patients after the jaundice vanished. Results： The jaundice was vanished within 2 weeks for all of the operative patients. Reduction in serum total bilirubin was seen in all patients,but only 85.7% and 58.8% respect for endoscopic stent insertion and percutaneous transhepatic biliary drainage cases reduced to normal level within 4 weeks. Serum total bilirubin decreasing was observed in 9 of the 12 minor jaundice patients received medicine treatment. Overall median survival was 7.5 months and 1 - year survival rate was 39.9%. Conclusion：The prognosis of obstructive jaundice due to recurrence gastric carcinoma is poor, adequate biliary drainage combined with appropriate chemotherapy/irradiation can improve the patient life quality and may prolong their survival time.