胃癌肝转移行手术切除的临床分析

Clinical analysis of hepatectomy for hepatic metastasis in 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。方法该院2008-01～2013-01共有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因素分析。结果 32例患者1、3、5年的生存率分别为84%、50%、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≥5 cm者预后不良。结论胃癌合并肝转移患者肝转移灶直径〈5 cm,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 with gastric cancer. Methods Thirty-two patients with gastric cancer had undergone hepatectomy for hepatic metastatic tumor from January 2008 to January 2013 in our hospital. Of them,16 patients underwent radical gastrectomy and synchronous hepatectomy for liver metastasis,the other 16 patients underwent radical resection of gastric cancer and liver resection heterochronously. The relationship between prognosis and clinicopathology was analyzed. Results The overall survival rates at 1year,3 years and 5 years were 84%,50% and 37%,respectively. The median survival time was 32 months. The single factor analysis showed that gastric cancer invasion depth,intravascular tumor thrombi,lymphatic metastasis and intraoperative blood transfusion were related to poor prognosis while the multiple factors analysis showed that gastric serosal invasion,tumor thrombus and liver metastasis tumor ≥5 cm were related to poor prognosis. Conclusion Gastric cancer patients with liver metastasis who underwent hepatic resection can achieve good prognosis if hepatic metastatic tumor 5 cm or the primary gastric cancer does not invade the serosa and without tumor thrombus.