胃癌合并肝硬化门脉高压症患者行根治术后出现并发症的危险因素及预后分析
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摘要
目的:探讨胃癌合并肝硬化门脉高压症患者行根治术后出现并发症的危险因素及预后特点。方法:收集2000年1月至2012年1月我院收治的123例行根治性切除术的胃癌合并肝硬化门脉高压症患者的临床资料。统计分析可能与术后并发症相关的危险因素,以电话或门诊复查等方式进行随访,分析术后并发症与患者长期生存的关系。结果:123例患者无一例围术期死亡。术后共78例(63.4%)患者出现了并发症,其中以腹水最为常见,共36例,其次分别为肺部感染22例、出血11例、切口感染10例、术后肝肾功能障碍9例、膈下感染7例。单因素分析结果显示,患者术后并发症的发生与肿瘤直径、上消化道出血史、Child分级、血清白蛋白、血小板、血红蛋白、术中出血量相关(P<0.05),但与患者性别、年龄、肿瘤部位、分期、肝硬化病因、手术方式、手术时间无关(P>0.05)。Logstic多因素分析发现,仅有Child分级、血清白蛋白、术中出血量是影响患者术后并发症发生的独立性危险因素(P<0.05)。截至随访日期,并发症组78例患者,死亡42例,5年生存率为46.1%(36/78);无并发症45例患者,死亡15例,5年生存率为66.7%(30/45)。两组患者总体生存率之间差异有统计学意义(P=0.023)。结论:对于胃癌合并肝硬化的患者,术后出现并发症是远期预后不良的重要信号。Child分级、血清白蛋白、术中出血量是影响术后并发症发生的最主要因素。术前积极调整Child分级,补充血清白蛋白,术中遵循减伤原则,控制出血,或能有效减少术后并发症发生。
Objective:To investigate the risk factors and prognosis of postoperative complications in patients with gastric cancer complicated with cirrhosis and portal hypertension.Methods:From January 2000 to January 2012,the clinical data of 123 cases of gastric cancer complicated with cirrhosis and portal hypertension treated by radical resection in our hospital were collected.The risk factors of postoperative complications were analyzed,and the relationship between postoperative complications and long-term survival was analyzed.Results:None of the 123 patients died during the perioperative period.A total of 78 cases(63.4%) of patients with postoperative complications occurred.The ascites was the most common,followed by a total of 36 cases,22 cases of pulmonary infection,11 cases of hemorrhage,10 cases of incision infection,9 cases of liver and kidney dysfunction after surgery,7 cases of subphrenic infection.Univariate analysis showed that the postoperative complications were correlated with tumor diameter,history of upper gastrointestinal bleeding,Child score,serum albumin,hemoglobin,platelet,bleeding volume(P<0.05),but not correlated with gender,age,tumor location,stage,etiology,surgical approach,the operation time(P>0.05).Logstic multivariate analysis showed that only Child classification,serum albumin and intraoperative blood loss were independent risk factors for postoperative complications(P<0.05).The 5 years survival rate in the complication group was 46.1%(36/78),and the 5 years survival rate in the non complication group was 66.7%(30/45).There was a statistically significant difference in overall survival between the two groups(P=0.023).Conclusion:For patients with gastric cancer and cirrhosis,Child classification,serum albumin,and intraoperative blood loss are the most important factors affecting postoperative complications.Preoperative adjustment of Child grading,serum albumin supplementation,intraoperative control of bleeding may reduce postoperative complications.
Objective:To investigate the risk factors and prognosis of postoperative complications in patients with gastric cancer complicated with cirrhosis and portal hypertension.Methods:From January 2000 to January 2012,the clinical data of 123 cases of gastric cancer complicated with cirrhosis and portal hypertension treated by radical resection in our hospital were collected.The risk factors of postoperative complications were analyzed,and the relationship between postoperative complications and long-term survival was analyzed.Results:None of the 123 patients died during the perioperative period.A total of 78 cases(63.4%) of patients with postoperative complications occurred.The ascites was the most common,followed by a total of 36 cases,22 cases of pulmonary infection,11 cases of hemorrhage,10 cases of incision infection,9 cases of liver and kidney dysfunction after surgery,7 cases of subphrenic infection.Univariate analysis showed that the postoperative complications were correlated with tumor diameter,history of upper gastrointestinal bleeding,Child score,serum albumin,hemoglobin,platelet,bleeding volume(P<0.05),but not correlated with gender,age,tumor location,stage,etiology,surgical approach,the operation time(P>0.05).Logstic multivariate analysis showed that only Child classification,serum albumin and intraoperative blood loss were independent risk factors for postoperative complications(P<0.05).The 5 years survival rate in the complication group was 46.1%(36/78),and the 5 years survival rate in the non complication group was 66.7%(30/45).There was a statistically significant difference in overall survival between the two groups(P=0.023).Conclusion:For patients with gastric cancer and cirrhosis,Child classification,serum albumin,and intraoperative blood loss are the most important factors affecting postoperative complications.Preoperative adjustment of Child grading,serum albumin supplementation,intraoperative control of bleeding may reduce postoperative complications.
引文
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[17] Tsutsumi N,Tomikawa M,Akahoshi T,et al.Pancreatic fistula after laparoscopic splenectomy in patients with hypersplenism due to liver cirrhosis:Effect of fibrin glue and polyglycolic acid felt on prophylaxis of postoperative complications[J].American Journal of Surgery,2016,212(5):882-888.
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[19] Kim DJ,Park CH,Kim W,et al.Safety of laparoscopic radical gastrectomy in gastric cancer patients with liver cirrhosis[J].Surgical Endoscopy & Other Interventional Techniques,2017,31(10):1-7.
[2] Jiang L,Sun HH,Guan QL,et al.The expression and clinical significance of HER2 in gastric cancer tissue [J].Tumor,2018,38 (3):222-228.[姜雷,孙慧慧,关泉林,等.胃癌组织中HER2的表达及其临床意义[J].肿瘤,2018,38(3):222-228.]
[3] Ikoma N,Estrella JS,Blum M,et al.Central lymph node metastasis in gastric cancer is predictive of survival after preoperative therapy[J].Journal of Gastrointestinal Surgery,2018,46(2):1-9.
[4] Zhang CD,Zong L,Ning FL,et al.Modified vs standard D2 lymphadenectomy in distal subtotal gastrectomy for locally advanced gastric cancer patients under 70 years of age[J].Oncology Letters,2018,15(1):375-385.
[5] Zhou YX,Yang LP,Wang ZX,et al.Lymph node staging systems in patients with gastric cancer treated with D2 resection plus adjuvant chemotherapy[J].Journal of Cancer,2018,9(4):660-666.
[6] Yang PF.Risk factors for postoperative complications in patients with gastric cancer complicated with cirrhosis and portal hypertension [J].World Clinical Medicine,2017,11(17):44.[杨鹏飞.胃癌合并肝硬化门脉高压患者手术后并发症的危险因素分析[J].世界临床医学,2017,11(17):44.]
[7] Zhan X,Chen Y,Wang Y.Laparoscopic splenectomy and subsequent oncologic gastric surgery in cirrhotic patients with portal hypertension and hypersplenism[J].Tumor,2018,29(1):132-133.
[8] Emmanuel Akintoye,Itegbemie Obaitan,Arunkumar Muthusamy,et al.Endoscopic submucosal dissection of gastric tumors:A systematic review and meta-analysis[J].World Journal of Gastrointestinal Endoscopy,2016,8(15):517.
[9] Kwo P,Gitlin N,Nahass R,et al.Simeprevir plus sofosbuvir (12 and 8 weeks) in hepatitis C virus genotype 1-infected patients without cirrhosis:OPTIMIST-1,a phase 3,randomized study[J].Hepatology,2016,64(2):370-380.
[10] Qu YH,Liang LT,Chen X,et al.The safety and efficacy of different surgical methods in the treatment of gastric cancer complicated with portal hypertension [J].Clinical Medicine,2017,37 (2):25-27.[区颖豪,粱丽婷,陈晓,等.不同术式治疗胃癌合并门静脉高压症的安全性及疗效分析[J].临床医学,2017,37(2):25-27.]
[11] Fullerton BS,Sparks EA,Hall AM,et al.Enteral autonomy,cirrhosis,and long term transplant-free survival in pediatric intestinal failure patients[J].Journal of Pediatric Surgery,2016,51(1):96-100.
[12] Xu Q,Gu L,Jiang C,et al.The selection of surgical treatment for gastric cancer patients with cirrhosis and hypersplenism[J].Hepato-gastroenterology,2014,61(129):232.
[13] Liu B,Yu M,Song Y,et al.Surgery for gastric cancer in a patient with non-cirrhotic hyperammonemia:A case report[J].World Journal of Surgical Oncology,2015,13(1):76.
[14] Ryu KW,Lee JH,Kim YW,et al.Management of ascites after radical surgery in gastric cancer patients with liver cirrhosis and minimal hepatic dysfunction[J].World Journal of Surgery,2005,29(5):653-656.
[15] Guo F,Ma S,Yang S,et al.Surgical strategy for gastric cancer patients with liver cirrhosis:A retrospective cohort study[J].International Journal of Surgery,2014,12(8):810-814.
[16] Garciatsao G.Current management of the complications of cirrhosis and portal hypertension:Variceal hemorrhage,ascites,and spontaneous bacterial peritonitis[J].Digestive Diseases,2016,34(4):382-386.
[17] Tsutsumi N,Tomikawa M,Akahoshi T,et al.Pancreatic fistula after laparoscopic splenectomy in patients with hypersplenism due to liver cirrhosis:Effect of fibrin glue and polyglycolic acid felt on prophylaxis of postoperative complications[J].American Journal of Surgery,2016,212(5):882-888.
[18] Jin ZX,Ma YY,Wang XY,et al.Treatment selection for gastric cancer with portal hypertension:Clinical management[J].Gastric Cancer,2014,17(2):302-309.
[19] Kim DJ,Park CH,Kim W,et al.Safety of laparoscopic radical gastrectomy in gastric cancer patients with liver cirrhosis[J].Surgical Endoscopy & Other Interventional Techniques,2017,31(10):1-7.