胃癌肝转移的手术治疗  

Hepatic resection for metastatic tumors from gastric carcinoma

作　　者：孙益红[1] 秦新裕[1] 汪学非[1] 马曾辰[2] 王承棓[1] 

机构地区：[1]复旦大学附属中山医院普通外科,上海200032 [2]复旦大学附属中山医院肝癌研究所,上海200032

出　　处：《中华胃肠外科杂志》2003年第5期301-304,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的 探讨胃癌肝转移行肝切除术的适应证及疗效。方法 对1990年1月至1999年11月间施行肝切除的24例胃癌肝转移患者的临床资料进行回顾性分析。结果 本组同时性肝转移19例,异时性转移5例。共施行肝段叶切除8例,肝部分切除16例;19例同时性肝转移患者均在肝切除的同时加行根治性胃切除术。术后并发肝昏迷死亡1例,手术死亡率为4.2％。全组22例获得随访。术后1年、3年和5年生存率分别为45.5％、18.2％和9.1％。生存分析显示,肝切除术后的生存率不仅与胃癌原发灶的分化程度、有无浆膜面浸润和淋巴结转移有关,而且与肝转移灶的数目及其在肝脏内的分布范围有关。结论 对于胃癌孤立性肝转移患者,其原发病灶可根治切除的应积极采用手术治疗,部分患者可获长期生存。Objective To investigate the indications and effect of hepatic resection for metastatic tumors originating from gastric adenocarcinoma. Methods A retrospective study of 24 patients undergoing hepatectomy for metastatic tumors from gastric adenocarcinoma from January 1990 to November 1999 was analyzed retrospectively. Results Among 24 patients, 19 were found to have synchronous hepatic metastases and 5 metachronous hepatic metastases. Liver metastases were removed by limited resection in 16 patients, and anatomic resections were performed in the other 8 patients. All patients with synchronous hepatic metastases received radical gastrectomy combined with hepatectomy. The operative mortality rate was 4.2%. The 1,3 and S-year survival rates were 45%, 18% and 9% respectively. Two patients survived for more than 5 years after surgery. Univariate analysis revealed that solitary metastasis was a significant factor for favorable prognosis after surgery. Depth of invasion, status of lymph node metastasis and histologic differentiation of the primary gastric cancer were all significant predictive factors regarding overall survival. Conclusions Hepatic resection should be attempted in patients with solitory hepatic metastases unless other incurable factors were present, and long-term survival could be anticipated for some selected patients.

关 键 词：胃癌 肝转移 手术治疗 肝切除术 适应证 疗效 

分 类 号：R735.2[医药卫生—肿瘤] R730.56[医药卫生—临床医学]