肝硬化门脉高压症合并贲门癌患者的手术治疗

Surgical strategie s in liver cirrhotic patients with carcinoma of gastric cardia

目的探讨肝硬化门脉高压症患者合并贲门癌的外科治疗策略。方法 24例肝硬化门脉高压症合并贲门癌患者接受外科手术治疗,对手术指征、手术方式、围手术期管理和近期预后的临床资料进行分析,并与同期30例无肝硬化的贲门癌患者的临床资料进行对比分析。结果肝硬化合并喷门癌患者术前血清ALT水平高于,白蛋白水平低于喷门癌患者;术后1周血清ALT、ALB和TBIL水平分别为88.8±22.5u/L、29.3±4.8g/L和31.2±13.4μmol/L,而喷门癌组则为29.1±6.1u/L、33.6±3.7u/L和14.6±4.6μmol/L(P<0.05);肝硬化组根治性癌肿切除、出血量、住院天数、医疗花费和疗效满意度分别为79.2%、656±567毫升、21.1±5.4天、31100±9108元和83.3%,而喷门癌组则为93.3%、298±156毫升(P<0.05)、13.9±1.4天(P<0.05)、26000±9870元(P<0.05)和70.0%。结论肝硬化门脉高压症合并贲门癌患者的手术治疗需要严格掌握手术指证、优化手术方式、加强术中止血和重视围手术期管理。

Objective To investigate the surgical strategies in liver cirrhotic patients with carcinoma of gastric cardia. Methods A retrospective analysis was studied in 24 cirrhotic portal hypertension patients with cardia cancer and the surgical procedure and perioperative management were compared with 30 patients with car-dia cancer. Results The serum ALT levels were higher,and the serum ALB levels were lower,in cirrhotic pa-tients before surgery than in patients without cirrhosis;the serum ALT,ALB and TBIL levels in cirrhotic patients one week after surgery were 88.8±22.5u/L,29.3±4.8g/L and 31.2±13.4μol/L,while they were 29.1±6.1u/L,33.6±3.7u/L and 14.6±4.6μol/L （P〈0.05）in patients without cirrhosis;the radical resection of tumor,amounts of bleeding,hos-pitalization days,costs and patients＇ satisfaction in cirrhotic patients were 79.2%,656±567ml,21.1±5.4 days, 31100±9108 yuan and 83.3%,while they were 93.3%,298±156 ml（P〈0.05）,13.9±1.4 days（P〈0.05）,26000±9870 yuan （P〈0.05）and 70.0%. Conclusion The surgical treatment of cirrhotic patients with portal hypertension and carcinoma of gastric cardia requires strict perioperative management and optimization of surgical operation.