Department of General Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200010, China; Surgical Laboratory, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200010, China; Central Laboratory, Huashan North Hospital, Shanghai Medical College, Fudan University, Shanghai 201907, China.
Department of Gynecology, Huashan North Hospital, Shanghai Medical College, Fudan University, Shanghai 201907, China; Central Laboratory, Huashan North Hospital, Shanghai Medical College, Fudan University, Shanghai 201907, China.
Int J Surg. 2014;12(8):810-4. doi: 10.1016/j.ijsu.2014.06.011. Epub 2014 Jul 5.
Recent studies have shown that radical gastrectomy with extended lymphadenectomy is feasible in gastric cancer patients with liver cirrhosis, but in those studies the main proportion was Child-Pugh class A patients. It is still difficult to choose reasonable surgical strategies for gastric cancer patients with cirrhosis, especially for Child-Pugh class B patients.
We reviewed the medical records of patients with liver cirrhosis who had undergone radical gastrectomy between January 2001 and December 2012. The clinical characteristics, postoperative complications, mortality and long-term outcomes in the 58 patients were investigated.
Severe complications and postoperative mortality occurred more frequently in class B patients than in class A patients (P < 0.05). In patients with class A and B, the complications and mortality rate was 37.5% and 4.2% in D1 lymph node dissection group and 71.9% and 25% in D2 lymph node dissection group, respectively. Kaplan-Meier survival analysis showed longer survival for class A patients than for class B patients (P < 0.05). For class B patients with advanced gastric cancer, D2 lymph node dissection could not provide a longer survival than D1 lymph node dissection (P = 0.282).
Radical operation with D1 or D2 lymph node dissection can be tolerated in class A gastric cancer patients. D1 lymph node dissection is recommended in class B patients, and radical gastrectomy is very dangerous, even fatal for class C patients.
最近的研究表明，对于合并肝硬化的胃癌患者，扩大淋巴结清扫的根治性胃切除术是可行的，但这些研究的主要比例为 Child-Pugh 分级 A 患者。对于合并肝硬化的胃癌患者，特别是 Child-Pugh 分级 B 患者，仍然难以选择合理的手术策略。
我们回顾了 2001 年 1 月至 2012 年 12 月期间接受根治性胃切除术的肝硬化患者的病历。研究了 58 例患者的临床特征、术后并发症、死亡率和长期预后。
B 级患者的严重并发症和术后死亡率明显高于 A 级患者（P < 0.05）。在 A 级和 B 级患者中，D1 淋巴结清扫组的并发症和死亡率分别为 37.5%和 4.2%，D2 淋巴结清扫组分别为 71.9%和 25%。Kaplan-Meier 生存分析显示 A 级患者的生存时间长于 B 级患者（P < 0.05）。对于进展期胃癌的 B 级患者，D2 淋巴结清扫并不能提供比 D1 淋巴结清扫更长的生存时间（P = 0.282）。
A 级胃癌患者可耐受 D1 或 D2 淋巴结清扫的根治性手术。B 级患者推荐行 D1 淋巴结清扫，而 C 级患者行根治性胃切除术非常危险，甚至致命。
