Nakashima H, Sugimachi K
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Nihon Geka Gakkai Zasshi. 1997 Aug;98(8):676-9.
Outcomes of surgery for gastric cancer or esophageal cancer in cirrhotic patients are not favorable. The preoperative assessment of liver function utilizing Child's classification or indocyanine green (ICG) excretion test can be a predictive factor of postoperative mortality. Operative risk is acceptable if patients are classified as Child's class A, and surgical procedures should be avoided in patients either classified as Child's class C or having ICG-R15 of 25% or more. To avoid postoperative complications, it is important to minimize the operative procedure and to ligate vessels instead of using electrocautery. Surgical stress and risk can further be reduced by a two stage operation for esophageal cancer and by gastrectomy with reduced lymph node dissection of D1 for gastric cancer. However, because curability of existing cancer is also required for surgical procedures, the status of liver cirrhosis and the stage of cancers should be considered in surgical treatment of gastric cancer or esophageal cancer in patients with liver cirrhosis.
肝硬化患者的胃癌或食管癌手术预后不佳。利用Child分级或吲哚菁绿（ICG）排泄试验对肝功能进行术前评估可作为术后死亡率的预测因素。如果患者被归类为Child A级，手术风险是可以接受的；而对于被归类为Child C级或吲哚菁绿滞留率（ICG-R15）达到或超过25%的患者，应避免进行手术。为避免术后并发症，尽量简化手术操作并结扎血管而非使用电灼术非常重要。对于食管癌采用两阶段手术，对于胃癌采用缩小淋巴结清扫范围的D1胃切除术，可进一步降低手术应激和风险。然而，由于手术治疗也需要考虑现有癌症的可治愈性，因此在对肝硬化患者的胃癌或食管癌进行手术治疗时，应综合考虑肝硬化的状况和癌症的分期。
