胃肠恶性肿瘤伴肝硬化门静脉高压症的外科治疗.pdf

消化外科2006第5卷第4期235-238

JournalofDigestiveSurgery,2006,5(4):235-238
235

文章编号:16714555(2006)04023504临床研究
胃肠恶性肿瘤伴肝硬化门静脉高压症的外科治疗

徐庆吴志勇顾磊罗蒙孙勇伟徐琳陈炜邱江锋

摘要!目的总结肝硬化门静脉高压症合并胃肠肿瘤患者围手术期处理经验。方法对2000年1
月至2005年7月收治的23例(17例胃肿瘤及6例结肠肿瘤)合并肝硬化门静脉高压症行手术治疗的胃肠
肿瘤患者资料进行回顾性分析研究。结果本组23例患者,治愈17例,死亡6例,死因为MODS5例,急
性肺栓塞1例,病死率为26.1%。死亡病例与肝功能分级有明显关系,ChildA级死亡1例(12.5%),B
级死亡2例(22.2%),C级死亡3例(50%)。发生吻合口漏1例,胰尾血管出血1例,未发生残胃缺血。
结论对合并有门静脉高压症的胃肠肿瘤患者,正确掌握其手术适应证和时机,加强围手术期处理,以降
低病死率和并发症发生率。
关键词!门静脉高压症;胃肿瘤;结肠肿瘤;肝硬化
中图法分类号!R657.3+4;R735.2;R735.5文献标识码!A

SurgicalmanagementofgastrointestinaltumorwithlivercirrhosisandportalhypertensionXUQing,WU
Zhiyong,GULei,LUOMeng,SUNYongwei,XULin,CHENWei,QIUJiangfeng.DepartmentofGen
eralSurgery,RenjiHospital,SchoolofMedicine,ShanghaiJiaotongUniversity,Shanghai200127,China
Abstract!ObjectiveTosumuptheexperienceintheperioperativemanagementofgastrointestinal
tumorwithlivercirrhosisandportalhypertension.MethodsAretrospectiveanalysiswasmadein23cases
withgastrointestinaltumorcombinedwithlivercirrhosisandportalhypertensiongastrictumorincluding17
withgastriccancerand6withintestinaltumoradmittedintoourhospitalfromJanuary2000toJuly2005.
ResultsOfall,17caseswerecuredbut6diedduetomultipleorgandysfunctionsyndromeMODS(5ca
ses)andacutepulmonaryembolism(1case),withmorbidityrateof26.1%.Deathwasobviouslycorrela
tedwithliverfunctionclassification,ie,therewas1deathatGradeA(12.5%),2atGradeB(22.2%)
and3atGradeC(50%).Leakageofstomaoccurredin1caseandbleedingofpancreatictailvesselin1,
withnoischemiaofresidualstomach.ConclusionsForcaseswithgastrointestinaltumorcombinedwithliv
ercirrhosisandportalhypertension,weshouldemphasizeonperioperativemanagementandmasterappro
priatesurgicalindicationtodecreasemortalityandincidencerateofcomplications.
Keywords!Portalhypertension;Gastrictumor;Colontumor;Cirrhosis

肝硬化门静脉高压症(portalhypertension,平均年龄60.7岁。其中胃肿瘤17例(胃癌16例,
PHT)具有特殊的病理生理学变化。当胃肠肿瘤合胃间质瘤1例),结肠癌6例。ChildPugh肝功能分
并肝硬化门脉高压症时,其手术治疗十分棘手,存在级:A级8例,B级9例,C级6例