老年人胃癌急性穿孔的外科疗效56例分析

Effects of surgery on perforated gastric cancer in elderly patients:analysis of 56 cases

目的探讨老年人胃癌急性穿孔患者的外科治疗方法。方法回顾性调查1996年至2006年间在外科治疗的56例60岁以上胃癌穿孔患者,男42例,女14例,平均年龄71岁(60～83岁)的临床资料,分析手术术式与生存期的相关性。结果大体类型多为溃疡型(45/56例,80·3%),病理多为低分化或未分化癌(49/56例,89·2%)。单纯穿孔修补术(或加胃空肠吻合术)26例,姑息性胃大部切除术20例,胃癌根治术10例。术后并发症发生率6·8%;手术死亡率1·4%,穿孔修补、姑息性切除、根治性切除术后1、3、5年生存率分别为3·8%、0%、0%;51·6%、24·8%、0%;78·3%、57·3%、21·2%。结论老年人胃癌急性穿孔病例常表现为一般情况差、溃疡及穿孔直径大等,应采取积极的治疗措施,可望延长患者的生存时间和提高患者的生存质量。

Objective To evaluate the effects of surgery on perforated gastric cancer in elderly patients.Methods The clinical data of 56 patients with perforated gastric cancer,42 males and 14 females,aged 71(68~83),who underwent operation.The relationship between operational pattern and survival period was analyzed.Results Pathological examination showed that according to gross type 45 of the 56 cases(80.3%) suffered from ulcerative cancer,and according to pathological type lowly differentiated or undifferentiated cancer accounted for 89.2%(49/56).Twenty-six cases received simple perforation repair,20 underwent subtotal gastrectomy,and 10 underwent radical gastrectomy.The postoperative complication rate was 6.8% and mortality was 1.4%.One-,3-,and 5-year survival rates were 3.8%,0,and 0 in the repair gastrectomy group;51.6%,24.8%,0 in partial group;78.3%.57.3%,21.2% in simple perforation repair group.Conclusion Advanced age,poor general condition,metastases,large size of ulcer and perforation are common factors of perforated gastric cancer.Surgical intervention should be conducted as soon as possible.Emergency gastrectomy is the first choice of operation.