胃癌急性穿孔不良结局的临床分析

Clinical analysis of poor outcomes after emergency surgery in gastric cancer patients with acute perforation

目的探讨胃癌穿孔围手术期死亡以及不同手术方式的影响因素,并分析其预后。方法对我院1998年1月至2010年9月收治的45例胃癌急性穿孔患者的临床资料进行回顾性分析。分析围手术期死亡的影响因素,比较不同手术方式的选择及预后。结果 45例胃癌急性穿孔患者中,2例行穿刺引流,11例单纯修补,18例姑息切除,14例根治切除。围手术期死亡率24.4%(11/45)。围手术期死亡和存活患者的平均年龄分别为(68.2±5.5)岁、(53.5±9.0)岁,平均穿孔时间分别为(19.4±5.3)h、(10.9±5.4)h,平均BMI分别为(15.1±1.3)kg/m2、(18.3±2.1)kg/m2,差异有统计学意义;围手术期死亡患者合并术前休克、内科疾病及远处转移的比例显著高于围手术期存活患者(P<0.01)。围手术期死亡多见于穿刺引流、单纯修补,姑息切除少见死亡,根治切除无死亡。穿刺引流、单纯修补、姑息切除、根治切除不同手术方式的选择与患者年龄、穿孔时间、BMI以及是否合并术前休克、内科疾病、远处转移相关(P<0.01)。单纯修补、姑息切除、根治切除组的中位生存期分别为9、15、29个月,生存率比较差异有统计学意义。结论胃癌急性穿孔围手术期死亡与患者一般情况、腹膜炎程度、肿瘤进展情况有关,对其综合、正确判断,选择合理手术方式,可降低围手术期死亡率,并可使部分患者获得根治机会,生存获益。

Objective To investigate the factors affecting peri-operative mortality and different surgical procedures in gastric cancer patients with acute perforation,and compare the survival after different surgical procedures. Methods Clinical data of 45 perforated gastric cancer patients surgically treated in our hospital from January 1998 to December 2009 were analyzed retrospectively. The factors affecting peri-operative mortality and reasons for choice of different surgical procedures were analyzed. The survival rates were compared among the different surgical procedures. Results Among the 45 perforated gastric cancer patients,abdominal puncture and drainage was performed in 2, simple suture in 11, palliative resection in 18 and radical resection in 14 cases. The peri-operative mortality was 24.4%(11/45). The median age,standing time of perforation and body mass index(BMI) of peri-operative deaths were (68.2±5.5) years, (19.4±5.3)h, (15.1±1.3)kg/m2 respectively, while those of peri-operative survivors (53.5±9.0) years, (10.9±5.4)h and (18.3±2.1)kg/m2(all P<0.01).The proportions of the patients with pre-operative shock, concomitant medical illnesses and distant metastasis in peri-operative death group were significantly higher than those in peri-operative survivor group. The choice of different surgical procedures was correlated with age, standing time of perforation,BMI, pre-operative shock,concomitant medical illnesses and distant metastasis. The median survival of the patients after simple suture, palliative resection and radical resection were 9.0, 15.0 and 29.0 months respectively(P<0.01). Conclusions The peri-operative mortality of perforated gastric cancer is associated with patients general condition, severity of acute peritonitis and late stage of gastric cancer. These affecting factors should be judged comprehensively and correctly in order that suitable surgical procedures can be selected and some selected patients may benefit from radical resection.