不同术式治疗胃癌合并门静脉高压症的安全性及疗效分析  

Safety and efficacy analysis of different surgical methods in the treatment of gastric cancer with portal hypertension

作　　者：区颖豪[1] 粱丽婷 陈晓[1] 黄灿东 

机构地区：[1]广东省肇庆市第一人民医院普外科,526040 [2]肇庆市中心血站检验科 [3]广西壮族自治区横县人民医院普外科

出　　处：《临床医学》2017年第2期25-27,共3页Clinical Medicine

摘　　要：目的探讨不同手术方式治疗胃癌合并门静脉高压症的临床疗效和安全性。方法回顾性分析2008年10月至2015年9月120例胃癌合并门静脉高压症患者的临床资料,按照治疗方式的不同分为分流术组和断流术组,每组60例。对比分析两组患者临床症状的改变情况以及随访结果。结果与断流术组患者相比,分流术组患者食管胃底静脉曲张和腹水的好转率明显增加,差异有统计学意义(P<0.05),而断流术组患者的肝功能改善情况明显优于分流术组(P<0.05);分流术组的再出血发生率为30.0%,明显高于断流术组(13.3%),差异有统计学意义(P<0.05);此外,分流术组4例患者出现肝性脑病,而断流术组患者无肝性脑病发生。两组患者死亡例数比较差异未见统计学意义(P>0.05)。结论断流术能够明显降低患者再出血发生率,对肝功能影响小,操作简单,是治疗胃癌合并门静脉高压症的理想手术治疗方式。Objective To investigate the clinical efficacy and safety of different surgical methods in the treatment of gastric cancer with portal hypertension. Methods From October 2008 to September 2015, the clinical data of 120 cases of gastric cancer complicated with portal hypertension were retrospectively analyzed, according to different treatment modali- ties, they were divided into shunt group and devascularization group, with 60 cases in each group. The changes of clinical symptoms in the two groups were compared and analyzed, and the follow-up results were also analyzed. Results Compared with devascularization group, the improved rates of the esophageal and gastric fundus varices increased significantly, the differences were significant （P 〈 0. 05 ）, and the liver function improvement in devascularization group was significantly better than that in the shunt group （P 〈 0.05 ） ; the rebleeding rate was 30. 0% in shunt group, which was significantly higher than that in devascularization group（ 13.3% ）, the difference was significant （ P 〈 0. 05 ）. In addition, the shunt group had 4 cases of hepatic encephalopathy, and devascularization group patients without hepatic encephalopathy, there was no significant difference in the number of deaths between the two groups （P 〉 0. 05）. Conclusion Devascularization surgery can significantly reduce the rebleeding rate and has little influence on liver function, simple operation, and it is the ideal surgical treatment for gastric cancer complicated with portal hypertension treatment.

关 键 词：胃癌 门静脉高压症 贲门周围血管断流术 分流术 临床疗效 

分 类 号：R735.2[医药卫生—肿瘤] R657.34[医药卫生—临床医学]