胃癌肝转移切除术32例

Hepatectomy for hepatic metastasis in 32 gastric cancer patients

目的探讨肝转移灶切除在胃癌肝转移中的意义及不同的临床因素对其预后的影响。方法2006-2012年32例胃癌合并肝转移患者行肝转移灶切除。16例患者同时进行胃癌根治术和肝转移灶切除术，其余16例先后完成胃癌根治术和肝转移灶切除术。通过临床及病理资料对患者的预后进行单因素及多元因素分析。结果32例患者1、3及5年的生存率分别是84％，50％及37％，中位生存期为32个月，单因素分析显示，原发胃癌侵犯浆膜、血管瘤栓、淋巴结转移和手术中输血与不良预后相关，多因素分析显示，原发胃癌侵犯浆膜、血管瘤栓和肝转移灶直径〉5cm者预后不良。结论胃癌合并肝转移患者肝转移灶直径〈5cm，原发胃癌未侵犯浆膜层及血管无瘤栓者肝转移灶切除后能取得较好的预后。

Objective To evaluate hepatectomy for liver metastasis in patients of gastric carcinoma. Methods Clinical data of 32 gastric cancer cases undergoing hepatectomy for hepatic metastatic tumor were reviewed retrospectively from 2006 to 2012. 16 cases underwent radical gastrectomy and synchronous hepatectomy for liver metastasis, the remaining 16 cases underwent radical resection of gastric cancer and liver resection heterochronously. The relationship between prognosis and clinicopathology was analyzed. Results The overall survival rates were 84%, 50% and 37% in 1 year, 3 years and 5 years. The median survival time was 32 months. Gastric cancer invasion depth, intravascular tumor thrombi, lymphatic metastasis and intraoperative blood transfusion was related to poor prognosis by single factor analysis, while gastric serosal invasion, tumor thrombus and liver metastasis tumor 〉 5 cm related to poor prognosis by multiple factors analysis. Conclusions Gastric cancer patients with liver metastasis who underwent hepatic resection can achieve good prognosis if hepatic metastatic tumor 〈 5cm or the primary gastric cancer does not invade the serosa and without tumor thrombus.