摘要
目的探讨胃癌合并门静脉高血压症的老年患者外科治疗方法，以期为临床治疗提供方法和依据。方法回顾性分析胃癌合并门静脉高血压症的老年患者88例，标准根治性切除35例，减瘤术38例，姑息手术9例，空肠造瘘术6例，观察手术并发症、死亡情况及死亡率、影响术后并发症的危险因素。结果手术平均时间（170±33）min；术中平均出血（490±100）ml。本组患者发生手术并发症共35例，占39．8％。其中，切口感染和吻合口瘘的发生率最高，分别为14．3％和11．4％。患者5年内，死亡69例，死亡率为78．4％。死亡原因中，因肝功能衰竭引发死亡最高，占21．7％。对造成术后死亡的危险因素进行Logistic回归分析，影响术后并发症的因素为年龄、肿瘤直径、手术时间和术中出血量95％CI分别为6．92～13．33、7．39～18．26、11．34～24．85、8．69～19．27。结论老年胃癌合并门静脉高血压症的外科治疗需要慎重选择，否则将带来严重的手术并发症，甚至危及患者生命。
Objective To investigate the surgical treatment method for senile gastric cancer complicated with portal hypertension. Methods Retrospective analysis was used for 88 elderly patients who suffered from gastric cancer complicated with portal hypertension. Among the cases, 35 cases were treated with standard radical resection, 38 cases treated with cytoreductive surgery, 9 cases with palliative operation, and 6 cases cured with jejunal fistula. Operation complications, death and mortality, the risk factors of postoperative complications were observed. Results For all the patients, the operation time was （170 ±33） min, and the intraoperative bleeding was （490± 100） ml. In 35 patients （39.8%） occurred operation complications, among which the incidence of incision infection and anastomotic leakage was the highest, which accounted for 14.3% and 11.4%, respectively. In 5 years, 69 patients were in death, the mortality rate was 78.4% which most resulted from liver failure （21.7%）. Logistic regression analysis showed that age, tumor diameter, operation time and perioperation bleeding were the risk factors for death （95% CI： 6.92-13.33,7.39-18.26, 11.34-24.85,8.69-19.27）. Conclusions The surgical approach for elderly gastric cancer patients complicated with portal hypertension should be chosen carefully, otherwise it will bring serious operation complications, and even endanger the lives of patients.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2012年第7期593-595,共3页
Chinese Journal of Geriatrics
关键词
胃肿瘤
高血压
门静脉
外科手术
Stomach neoplasms Hypertension, portall Surgical procedures, operative
