胃癌术后梗阻性黄疸手术治疗可行性和有效性分析
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摘要
目的探讨胃癌术后梗阻性黄疸手术治疗的可行性及有效性。方法选择41例胃癌术后梗阻性黄疸患者,观察组21例实施手术治疗,对照组20例患者则予内科保守治疗,比较两组治疗后1周肝功能改变及临床症状缓解时间,并行两组1年内生存曲线统计。结果治疗后1周观察组谷丙转氨酶和谷草转氨酶均显著低于对照组(P<0.01),且总胆红素和直接胆红素亦低于对照组(P<0.01),观察组皮肤黄染、巩膜黄染和皮肤瘙痒的消退时间均显著快于对照组(P<0.01),治疗后1个月、6个月和12个月观察组的生存时间均高于对照组。结论胃癌术后患者应加强随访,一旦可能发生黄疸者,果断实施根治性手术能有效提高患者生存时间和生活质量。
Objective To investigate the effectiveness and feasibility of operation for postoperative obstructive jaundice of patients with gastric cancer.Methods 41cases with obstructive jaundice after surgery for gastric cancer were divided into the observation group(21cases)and the control group(20cases).The observation group were treated with operation,while the control group were given conservative treatment of internal medicine.After one week of treatment,the change of liver function and the time of symptom alleviation between two groups were compared.Meanwhile,the survival curves of both groups within 1year were drawed and counted.Results After one week of treatment,the liver alanine aminotransferase and aspartate aminotransferase of the observation group were significantly lower than those of the control group(P<0.01).Their total bilirubin and direct bilirubin were also significantly lower than those of the control group(P <0.01).Besides,their time needed for disappearance of skin yellowing,sclera yellowing and skin pruritus was also significantly shorter than that of the control group(P <0.01).The observation group had longer survival time than the control group after 1month,6months,and 12months of treatment.Conclusion Follow-up visits for gastric cancer patients should be strengthened after operation.Once patients get jaundice,to decisively implement radical surgery can extend patients' survival time and improve their quality of life.
Objective To investigate the effectiveness and feasibility of operation for postoperative obstructive jaundice of patients with gastric cancer.Methods 41cases with obstructive jaundice after surgery for gastric cancer were divided into the observation group(21cases)and the control group(20cases).The observation group were treated with operation,while the control group were given conservative treatment of internal medicine.After one week of treatment,the change of liver function and the time of symptom alleviation between two groups were compared.Meanwhile,the survival curves of both groups within 1year were drawed and counted.Results After one week of treatment,the liver alanine aminotransferase and aspartate aminotransferase of the observation group were significantly lower than those of the control group(P<0.01).Their total bilirubin and direct bilirubin were also significantly lower than those of the control group(P <0.01).Besides,their time needed for disappearance of skin yellowing,sclera yellowing and skin pruritus was also significantly shorter than that of the control group(P <0.01).The observation group had longer survival time than the control group after 1month,6months,and 12months of treatment.Conclusion Follow-up visits for gastric cancer patients should be strengthened after operation.Once patients get jaundice,to decisively implement radical surgery can extend patients' survival time and improve their quality of life.
引文
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[3]Maluf-Filho F,Retes FA,Neves CZ.Transduodenal endosonography-guided biliary drainage and duodenal stenting for palliation of malignant obstructive jaundice and duodenal obstruction[J].JOP,2012,13(2):210-214.
[4]何旭,顾建平,楼文胜,等.经皮肝穿刺金属内支架置入治疗胆道恶性阻塞性黄疸的临床疗效[J].中国医疗设备杂志,2011,26(10):18-20.
[5]张伟,胡还章.胃癌手术后梗阻性黄疸的外科治疗[J].中国普通外科杂志,2007,16(4):392-393.
[6]王湘辉,王海忠,上官建营,等.胃癌术后复发致梗阻性黄疸的挽救治疗[J].现代肿瘤医学,2013,21(2):356-358.
[7]牛洪涛,翟仁友,王剑锋,等.胃癌合并梗阻性黄疸经皮经肝胆道引流术后中、长期疗效分析[J].介入放射学杂志,2011,20(3):227-230.
[8]Goto T,Nemoto H,Shinmura K.Complete response to S-1/CDDP combination in a patient with obstructive jaundice secondary to lymph node metastasis by gastric cancer-a case report[J].Gan To Kagaku Ryoho,2011,38(7):1197-1200.
[9]许学杰,林元美,刘国泉,等.胃癌术后复发所致梗阻性黄疸26例分析[J].肿瘤学杂志,2009,11(5):392.
[2]欧盛秋.马亦龙.康平,等.经皮肝穿刺胆道内支架置入术结合动脉化疗栓塞术治疗恶性胆道梗阻[J].重庆医学,2008,37(19):2215-2216.
[3]Maluf-Filho F,Retes FA,Neves CZ.Transduodenal endosonography-guided biliary drainage and duodenal stenting for palliation of malignant obstructive jaundice and duodenal obstruction[J].JOP,2012,13(2):210-214.
[4]何旭,顾建平,楼文胜,等.经皮肝穿刺金属内支架置入治疗胆道恶性阻塞性黄疸的临床疗效[J].中国医疗设备杂志,2011,26(10):18-20.
[5]张伟,胡还章.胃癌手术后梗阻性黄疸的外科治疗[J].中国普通外科杂志,2007,16(4):392-393.
[6]王湘辉,王海忠,上官建营,等.胃癌术后复发致梗阻性黄疸的挽救治疗[J].现代肿瘤医学,2013,21(2):356-358.
[7]牛洪涛,翟仁友,王剑锋,等.胃癌合并梗阻性黄疸经皮经肝胆道引流术后中、长期疗效分析[J].介入放射学杂志,2011,20(3):227-230.
[8]Goto T,Nemoto H,Shinmura K.Complete response to S-1/CDDP combination in a patient with obstructive jaundice secondary to lymph node metastasis by gastric cancer-a case report[J].Gan To Kagaku Ryoho,2011,38(7):1197-1200.
[9]许学杰,林元美,刘国泉,等.胃癌术后复发所致梗阻性黄疸26例分析[J].肿瘤学杂志,2009,11(5):392.