39例首发急症贲门癌的外科治疗体会

Surgical Treatment Experience of 39 Cases with Cardiac Cancer of the First Symptoms Presented as Acute Abdomen

目的总结首发大出血和穿孔急腹症贲门癌的外科治疗经验。方法回顾1990--2004年39例首发急症贲门癌临床治疗情况，其中首发大出血28例，首发穿孔11例；男32例，女7例，年龄48～73岁；确诊后均急诊手术治疗，单纯开腹修补穿孔2例，其余37例均采用左后外开胸贲门癌切除。病理：早期腺癌2例，中分化腺癌12例，低分化腺癌16例，黏液腺癌4例，印戒细胞癌3例；TNN分期：I期2例，Ⅱ期9例，Ⅲ期22例，Ⅳ期4例。结果39例无手术死亡，术后1、3、5、10年生存率分别为67．7％（21／31）、48．O％（12／25）、28．6％（6／21）、11．1％（1／9）。结论首发大出血或穿孔急症的贲门癌并不代表肿瘤属于很晚期不能切除，若无明显手术禁忌证，宜尽早手术治疗，综合治疗可提高远期生存率。

Objective To summarize the surgical treatment experience in gastric cardiac cancer of first symptom presented as acute abdomen, such as hemorrhea and perforation. Methods The clinical data of 39 cases with cardiac cancer of first symptom presented as acute abdomen, from 1990 to 2004, were retrospectively analyzed. Among 39 patients, there were 28 patients of first symptom were hemorrhage, and 11 patients were perforation. Once exactly diagnosed, the 39 patients （ 32 males and 7 females, of ages from 48 to 73 ）, received emergency operations. 2 patients received simple perforation repairation with peritoneotomy, other 37 patients received cardiac cancer resection with left thoracotomy. The postoperational pathologic type was 2 cases with early adenocarcinoma, 12 adenocarcinomas with moderate differentiation, 16 adenocarcinomas with poorly differentiation, 4 mucinous adenocarcinomas and 3 signet-ring cell carcinomas. The postoperational TNM staging was 2 cases of stage I , 9 stage 11 , 22 stage m and 4 stage IV. Results There was no operation-related death in all the 39 patients. The 1-year, 3-year, 5-year and 10-year postoperational survial were 67.7% （21/31）, 48.0% （ 12/25）, 28. 6% （6/21） and 11.1% （1/9）, respectively. Conclusion The first symptoms presented as acute abdomen, such as hemorrhage and perforation, they do not mean that cardiac cancer had been too late stage to be resected. If there is no surgical contraindieation, these patients should be operated as soon as possible. Combined therapy may improve the long-term survival.