胃癌同时性肝转移的临床病理分析和外科治疗效果评价

目的分析影响胃癌同时性肝转移的临床病理因素，探讨胃癌肝转移的治疗方法。方法回顾性分析1994年8月至2004年2月间收治的44例胃癌同时性肝转移患者的病例资料，并与同期收治的无转移的576例胃癌病例资料进行比较，分析影响同时性肝转移的临床病理因素。对胃癌肝转移根治性切除、姑息性切除和探查性手术的生存状况进行分析比较。结果单因素分析显示，腹水、盆结节、腹膜侵犯、浆膜浸润、淋巴结转移、周围脏器受累以及肿瘤Borrmarm分型、浸润深度都与胃癌肝转移有关（P〈0．01）；Logistic回归分析发现，腹膜侵犯（P=0．003）、浆膜浸润（P=0．000）、淋巴结转移（P=0．081）是影响胃癌肝转移最重要的因素。本组胃癌肝转移患者行根治性切除16例（36．4％），姑息性切除15例（34．1），探察性手术13例（29．5％）；中位生存期分别为19．5、11．0和6．2个月：3组比较差异有统计学意义（P〈0．05）。结论胃癌肝转移是胃癌的晚期事件；根治性切除胃癌原发病灶和肝转移灶，仍然可以明显提高患者的生存率。

Clinicopathological analysis of synchronous liver metastasis in gastric cancer and evaluation of surgical outcomes

Objective To analyze the clinicopathological factors affecting synchronous liver metastasis in gastric cancer,and evaluate its surgical outcome. Methods Clinical data of 44 patients with synchronous hepatic metastasis from gastric cancer from Aug. 1994 to Feb. 2004 were reviewed retrospectively,and compared with those of 576 gastric cancer patients without hepatic metastasis to analyze the clinicopathological factors affecting synchronous liver metastasis from gastric cancer. The survivals after radical resection,palliative and exploratory operation were compared. Results Univariate analysis revealed that ascites,pelvic and peritoneal seeding,serosal invision,lymph node metastasis,involvement of neighboring organs,Borrmann types,depth of infiltration were correlated with synchronous hepatic metastasis from gastric cancer (P< 0.01). Logistic regression showed peritoneal seeding (P=0.003,OR=1.629),serosal infiltration(P=0.000,OR=3.000),lymph node metastasis(P=0.081.OR=1.689) were independent risk factors for synchronous hepatic metastasis from gastric cancer. Sixteen(36.4%) patients received radical excision,15 (34.1%)patients palliative operation,and 13(29.5%) patients exploratory operation,and the median survival times were19.5,11.0 and 6.2 months respectively(P< 0.05). Conclusions Peritoneal seeding,serosal infiltration,lymph node metastasis are most important risk factors for synchronous hepatic metastasis from gastric cancer. Radical resection of gastric primary lesion and hepatic metastases can significantly prolong survival time.