胃癌术后复发致梗阻性黄疸的挽救治疗.pdfVIP

· 356 · 王湘辉，等 胃癌术后复发致梗阻性黄疸的挽救治疗 胃癌术后复发致梗阻性黄疸的挽救治疗 王湘辉 ，王海忠 ，上官建营 ，吕志诚 Salvagetherapyforpostoperativeobstructionjaundiceofgastriccancer WangXianghui，WangHaizhong，ShangguanJianying，LvZhicheng DepartmentofHepatobiliarySM ；Oncology，LanzhouGeneralHospital，LanzhouCommandP ，GansuLanzhou730050，China． 【Abstract】 0bjective：Tosummarizethetreatmentexperienceofobstructivejaundiceinpatientsofrecurrencegas— triccarcinoma．Methods：Totalof48patientsadmittedfrom2001to2010withextrahepaticbiliaryobstructioncaused byrecurrencegastriccancerwereretrospectivelyanalyzed，31ofthesecasesweremaleand17werefemale，forwhich 42casesunderwentradicalsurgeryand6casespalliativesurgeryinprevioussurgery．Thejaundiceemergedwithin6 months。6—12months，12—24monthsandmorethan24monthsin5cases，14cases，17casesand12 casesrespect frompreviousgastretomy．12patientsundewrentsurgeryproceduresincludingcholedochojejunostomyin4casesand insertionofTtubein8cases．7patientsunderwentendoscopicinsertionofstentand17patientsreceivedbiliaryde— compressionbypercutaneoustranshepatiebiliarydrainage．Foranother12patients，theyonlyreceivedmedicinetreat— ment．Chemotherapyand／orradiotherapywerecarriedoutin34patientsafterthejaundicevanished．Results：The jaundicewasvanishedwithin2weeksforalloftheoperativepatients．Reductioninseurm totalbilirubinwasseenin allpatients．butonly85．7％ and58．8％ respectofrendoscopicstentinsertionandpercutaneoustranshepaticbiliary drainagecasesreducedtonormallevelwithin4weeks．Serum totalbilirubindecreasingwasobservedin9 ofthe12 minorjaundicepatientsreceivedmedicinetreatment．Overallmediansurvivalwas7．5monthsand1一yearsurvival ratewas39．9％．Conclusion：Theprognosisofobstructivejaundiceduetorecurrencegastricc~cinomaispoor，ade— quatebiliarydrainagecombinedwith appropriatechemotherapy／irradiationcan improvethepatientlifequalityand