CAJ | 학술논문

目的探讨胃癌合并门静脉高压症的手术方式选择.方法回顾分析近5年内手术治疗的22例胃癌合并门静脉高压症临床资料,其中肝功能Child A级12例,Child B级10例.具体术式:全胃切除+贲门周围血管离断术11例,远端胃切除术9例,远端胃切除+脾切除术1例,远端胃切除+贲门周围血管离断术+保留胃后及左膈下动脉1例.肝功能Child A级患者均行胃癌D2根治术,Child B级患者均行胃癌D1根治术.术中均行肝活检.结果本组手术并发症发生率为50%,死亡率为9%.肝功能Child A级患者行D2根治术的术后肝功能恶化率为42%,Child B级患者行D1根治术的术后肝功能恶化率为70%,两者相比差异无统计学意义(P＞0.05),但前者并发症发生率为25%,后者并发症发生率为80%,两者相比差异有统计学意义(P＜0.05).同期处理门静脉高压症的术后并发症发生率为77%,未处理门静脉高压症的术后并发症发生率为11%,两者相比差异有统计学意义(P＜0.05).结论胃癌合并门静脉高压症的外科治疗须根据患者的肝功能分级和门静脉高压程度等因素采取个体化处理.
목적 탐토위암합병문정맥고압증적수술방식선택.방법 회고분석근5년내수술치료적22례위암합병문정맥고압증림상자료,기중간공능Child A급12례,Child B급10례.구체술식:전위절제+분문주위혈관리단술11례,원단위절제술9례,원단위절제+비절제술1례,원단위절제+분문주위혈관리단술+보류위후급좌격하동맥1례.간공능Child A급환자균행위암D2근치술,Child B급환자균행위암D1근치술.술중균행간활검.결과 본조수술병발증발생솔위50%,사망솔위9%.간공능Child A급환자행D2근치술적술후간공능악화솔위42%,Child B급환자행D1근치술적술후간공능악화솔위70%,량자상비차이무통계학의의(P＞0.05),단전자병발증발생솔위25%,후자병발증발생솔위80%,량자상비차이유통계학의의(P＜0.05).동기처리문정맥고압증적술후병발증발생솔위77%,미처리문정맥고압증적술후병발증발생솔위11%,량자상비차이유통계학의의(P＜0.05).결론 위암합병문정맥고압증적외과치료수근거환자적간공능분급화문정맥고압정도등인소채취개체화처리.
Objective To evaluate the surgical approaches for gastric carcinoma accompanied by portal hypertension ( PHT).Methods The clinical data of 22 patients with PHT undergoing operation during 5 years were retrospectively analyzed.The liver function was Child's A in 12 cases, Child's B in 10 cases.Total gastrectomy + pericardial devascularization was performed in 11 cases, distal subtotal gastrectomy in 9 cases, distal subtotal gastrectomy + splenectomy in one, distal subtotal gastrectomy + pericardial devascularization in one.12 cases with Child's A underwent D2 lymph node (LN) dissection and 10 cases with Child's B were treated with D1 LN dissection.Liver biopsy was taken in all patients.Results Postoperative complications developed in 50% and mortality rate was 9%.The rate of liver function deterioration in patients of Child A ungergoing D2 lymph node dissection was 42% , and that of patients with Child B was 70%.The rate of postoperatiave complications in patients with Child A ungergoing D2 lymph node dissection was 25% , while that of patients with Child B was 80%.There was no significant difference in liver function deterioration rate between Child A and Child B (P ＞ 0.05) , but the rate of postoperative complications in Child A is much lower than those in Child B(P ＜ 0.05).The complication rate in patients receiving PHT targeting measures was 77% ,much higher than 11% in those without concurrent treatment of PHT ( P ＜ 0.05 ).Conclusions Individualized surgical approache is crucial for treatment of gastric carcinoma accompanied by PHT.Surgical treatment should be on the basis of liver function and the severity of PHT.