Takeda J, Hashimoto K, Tanaka T, Koufuji K, Kakegawa T
First Department of Surgery, Kurume University School of Medicine, Japan.
Hepatogastroenterology. 1992 Oct;39(5):433-6.
Prognosis following surgery for gastric cancer has markedly improved as a result of early diagnosis, advances in operative techniques, and perioperative management. However, gastrointestinal surgery in patients with hepatic cirrhosis has continued to be associated with a high operative morbidity and mortality. On the basis of a detailed classification of the preoperative hepatic conditions into three risk groups, we have established a preoperative means of assessing surgical indication. Depending on the preoperative assessment, 40 gastric cancer patients with hepatic cirrhosis underwent surgical exploration. Thirty-seven patients (92.5%) received gastric resection, while 3 patients (7.5%) were non-resectable. Postoperative complications occurred in only 8 patients (20%), and no anastomotic leakage occurred; the overall operative mortality was zero. The five-year-survival rate following a curative resection, as calculated by Kaplan-Meier statistical analysis, was 51.4% (n = 30).
由于早期诊断、手术技术的进步以及围手术期管理，胃癌手术后的预后有了显著改善。然而，肝硬化患者的胃肠手术仍然与高手术发病率和死亡率相关。基于将术前肝脏状况详细分为三个风险组，我们建立了一种术前评估手术指征的方法。根据术前评估，40例肝硬化胃癌患者接受了手术探查。37例患者（92.5%）接受了胃切除术，3例患者（7.5%）无法切除。术后仅8例患者（20%）出现并发症，未发生吻合口漏；总体手术死亡率为零。通过Kaplan-Meier统计分析计算，根治性切除后的五年生存率为51.4%（n = 30）。
