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首页> 外文期刊>World Journal of Gastroenterology >Gastric cancer surgery in cirrhotic patients: Result of gastrectomy with D2 lymph node dissection.
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Gastric cancer surgery in cirrhotic patients: Result of gastrectomy with D2 lymph node dissection.

机译：肝硬化患者的胃癌手术：D2淋巴结清扫术胃切除术的结果。

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AIM: To explore the feasibility of performing gastrectomy with D2 lymphadenectomy in gastric cancer patients with liver cirrhosis. METHODS: A total of 7 178 patients were admitted with a diagnosis of liver cirrhosis from January 1993 to December 2003. We reviewed the records of 142 patients who were diagnosed with liver cirrhosis and gastric adenocarcinoma during the same period. Gastrectomy with D2 lymph node dissection for carcinoma of the stomach was performed in 94 patients with histologically proven hepatic cirrhosis. RESULTS: All but 12 patients were classified as Child's class A. Only 35 patients (37.2%) were diagnosed with cirrhosis before operation. Seventy-three patients underwent a subtotal gastrectomy (77.7%) and 21 patients (22.3%) underwent a total gastrectomy, each with D2 or more lymph node dissection. Two patients (3.8%) who had prophylactic intra-operative drain placement, died of postoperative complications from hepatorenal failure with intractable ascites. Thirty-seven patients (39.4%) experienced postoperative complications. The extent of gastric resection did not influence the morbidity whereas serum aspartate aminotransferase level (P = 0.011) and transfusion did (P = 0.008). The most common postoperative complication was ascites (13.9%) followed by wound infection (10.6%). CONCLUSION: We concluded that the presence of compensated cirrhosis, i.e. Child class A, is not a contraindication against gastrectomy with D2 or more lymph node dissection, when curative resection for gastric cancer is possible. Hepatic reserve and meticulous hemostasis are the likely determinants of operative prognosis.
机译：目的：探讨D2淋巴结清扫术在胃癌肝硬化患者中进行胃切除的可行性。方法：从1993年1月至2003年12月，共收治了7 178例诊断为肝硬化的患者。我们回顾了同期142例被诊断为肝硬化和胃腺癌的患者的记录。 94例经组织学证实为肝硬化的患者进行了D2淋巴结清扫术以治疗胃癌。结果：除12例患者外，所有患者均被归类为儿童A级。只有35例（37.2％）患者在手术前被诊断出患有肝硬化。 73例接受了全胃切除术（77.7％），21例（22.3％）接受了全胃切除术，每例均行D2或以上淋巴结清扫术。预防性术中引流放置的两名患者（3.8％）死于肝肾衰竭伴顽固性腹水的术后并发症。三十七名患者（39.4％）发生了术后并发症。胃切除的程度不影响发病率，而血清天冬氨酸转氨酶水平（P = 0.011）和输血影响（P = 0.008）。术后最常见的并发症是腹水（13.9％），其次是伤口感染（10.6％）。结论：我们得出结论，当可能进行胃癌根治性切除时，代偿性肝硬化（即A类儿童）的存在并不是D2或更多淋巴结清扫术对胃切除术的禁忌症。肝储备和细致止血可能是手术预后的决定因素。

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