胃癌合并肝硬化门静脉高压症的治疗  

Surgical management of gastric cancer with liver cirrhosis and portal hypertension

作　　者：高卫国[1] 赵长勇[2] 陆继宏[1] 张杰[1] 孙卫东[1] 

机构地区：[1]南京中医药大学附属扬州市中医院普外科,江苏省225009 [2]江苏大学附属人民医院外科

出　　处：《中华普通外科杂志》2010年第9期713-716,共4页Chinese Journal of General Surgery

摘　　要：目的 总结胃癌合并肝硬化门静脉高压症患者手术及围手术期的处理经验.方法 对2000年1月至2009年6月收治的35例胃癌合并肝硬化门静脉高压症患者行手术治疗的资料进行回顾性分析.结果 本组术中无死亡.术后发生腹水19例,吻合口漏1例,吻合口出血2例,创面渗血2例,腹腔感染17例（其中合并霉菌感染4例）,切口感染、乳糜漏各1例,术后并发症发生率为71%.住院期间死亡4例,其中急性肝功能衰竭所致多器官功能障碍综合征2例,死亡率为11%.结论 完善的术前评估,正确的围手术期处理,用＂损伤控制＂理念指导手术,实行个体化手术方案,重视预防性断流术,才能减少胃癌合并肝硬化门静脉高压症患者的病死率和并发症的发生率.Objective To review the experience in the management of gastric cancer with liver cirrhosis and portal hypertension.Method A retrospective analysis was made in 35 gastric cancer cases with liver cirrhosis and portal hypertension admitted into our hospital from January 2000 through June 2009.Result There were no intraoperative death in this group.Postoperative ascites occurred in 19 patients,anastomotic leakage in one case,anastomotic bleeding in 2 cases,wound bleeding in 2 cases,intraabdominal infection in 17 cases （of which combined fungal infection in 4 patients）,incision infection in one patient and chylous leakage in one case.The morbidity rate was 71%.Four patients died during hospitalization including multiple organ dysfunction syndrome in 2 cases,with mortality rate of 11%. Conclusion In order to reduce the incidence of mortality and complications,we should complete preoperative evaluation,correct perioperative management,guide surgery with damage control concept,follow individualized principles and emphasize on preventive devascularization.

关 键 词：胃肿瘤 高血压 门静脉 肝硬化 胃切除术 

分 类 号：R686[医药卫生—骨科学]