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目的探讨胃癌合并肝硬化门脉高压症的临床特征和治疗方法。方法回顾性分析2000年1月至2007年12月我院收治的42例胃癌合并肝硬化门脉高压症患者的临床资料,其中手术治疗30例。结果12例未行手术治疗者均在胃癌诊断后1年内死亡。手术患者无围手术期死亡,其中27例获得随访,随访时间3个月至8年,中位随访时间3年,1,3,5年生存率分别为74.1%(20/27)、44.5%(12/27)和22.2%(6/27),死亡原因:2例死于化疗后白细胞显著下降所致的严重感染和急性肝功能衰竭,1例死于上消化道大出血,其余患者死于胃癌复发和转移。结论胃癌合并门脉高压症患者手术并发症发生率高,手术方式需根据肝功能情况、上消化道出血史以及肿瘤的部位等采用“个体化”原则。加强围手术期处理和选择适当的辅助治疗有利于改善患者的预后。
Objective To investigate the clinical features and treatment of gastric cancer with cirrhosis and portal hypertension. Methods The clinical data of 42 patients with gastric cancer complicated with cirrhosis and portal hypertension treated in our hospital from January 2000 to December 2007 were analyzed retrospectively. Among them, 30 cases were treated surgically. Results All 12 patients who did not undergo surgery died within 1 year after diagnosis of gastric cancer. Surgical patients without perioperative deaths, including 27 cases were followed up for 3 months to 8 years, with a median follow-up time of 3 years, 1,3,5-year survival rates were 74.1% (20/27), 44.5% (12/27) and 22.2% (6/27), respectively. The causes of death were as follows: 2 died of severe infection and acute liver failure caused by significant decrease of white blood cells after chemotherapy, 1 died of upper gastrointestinal bleeding and the rest died Gastric cancer recurrence and metastasis. Conclusion The incidence of surgical complications in patients with gastric cancer complicated by portal hypertension is high. The surgical method should be based on the principle of liver function, upper gastrointestinal bleeding and the location of the tumor. To strengthen the perioperative management and select the appropriate adjuvant therapy is conducive to improving the prognosis of patients.