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目的分析治疗合并失代偿期肝硬化胃癌病人的合理手术方式。方法回顾性分析2001年1月至2013年12月复旦大学附属华山医院收治的65例胃癌合并肝硬化病人的临床资料,均行手术治疗并进行术后随访。结果肝功能Child-PughB级病人的术后严重并发症发生率和围手术期病死率为65.7%和22.9%,其中行D2淋巴结清扫病人术后肝功能衰竭和围手术期病死率为41.2%,而行D1淋巴结清扫病人为5.5%。对于肝功能Child-Pugh B级的进展期胃癌病人,D2淋巴结清扫不能为病人带来生存获益。结论在合并失代偿期肝硬化的胃癌病人的治疗中,D1淋巴结清扫的根治性手术对肝功能Child-PughB级病人更加安全有效。
Objective To analyze the reasonable operation of treating patients with gastric cancer with decompensated cirrhosis. Methods The clinical data of 65 patients with gastric cancer with cirrhosis admitted from Huashan Hospital Affiliated to Fudan University from January 2001 to December 2013 were retrospectively analyzed. All patients underwent surgical treatment and were followed up. Results The postoperative serious complication rate and perioperative mortality rate of Child-Pugh class B patients with liver function were 65.7% and 22.9%, respectively. The postoperative mortality and perioperative mortality rate of patients with D2 lymph node dissection was 41.2% The line D1 lymph node dissection patients 5.5%. For patients with advanced gastric cancer with Child-Pugh class B liver function, D2 lymph node dissection can not bring survival benefit to the patient. Conclusions In the treatment of patients with gastric cancer with decompensated cirrhosis, the radical operation of D1 lymph node dissection is more safe and effective for liver function Child-PughB class patients.