胃癌急性穿孔的外科治疗

Surgical treatment for acute perforation of gastric cancer

目的:探讨胃癌穿孔合理的术式选择。方法:胃癌穿孔24例,TNM分期Ⅱ期5例,Ⅲ期14例,Ⅳ期5例。穿孔修补5例(单纯穿孔修补3例,穿孔修补加胃空肠吻合2例),姑息切除(胃大部加大网膜切除)11例,根治性切除8例(D1淋巴结清扫6例,D2淋巴结清扫2例)。结果:治愈23例,病死1例。3种术式平均生存时间分别为5.6、15.2及28.2个月。结论:根治性胃癌切除加D1淋巴结清扫是胃癌穿孔合理的手术方式,对无根治条件者争取行姑息性手术切除。

Objective:To explore an appropriate procedure for treatment of acute perforation of gastric cancer.Methods:Twenty-four cases of perforated gastric cancer were included in the study.Among them,5 were in TNM stage Ⅱ,14 in stage Ⅲ and 5 in stage Ⅳ.Five cases were treated with repair of perforation(3 cases received simple repair of perforation,2 cases repair and gastrojejunestomy),11 cases with partial gastrectomy and great omentectomy,and 8 cases with radical resection(6 with clearance of lymph nodes in D1 and 2 with clearance in D2).Results:Twenty-three cases were cured and 1 case died.The median survival time of the patients treated with the 3 procedures was 5.6,15.2 and 28.2 months,respectively.Conclusions:Radical resection with D1 resection is the appropriate operative procedure for treatment of acute perforation of gastric cancer.For those who could not receceive radical resection,palliative resection is suggested.