胃癌急性穿孔的外科诊断和治疗

Diagnosis and surgical treatment of acute perforation of gastric cancer

目的探讨胃癌急性穿孔患者的诊断、治疗方法及预后情况。方法回顾性分析1996年7月至2008年12月广州总医院收治的24例胃癌急性穿孔患者的临床资料、诊断、手术及术后生存情况，采用LSD法检验均数间的两两比较。结果24例患者中，行单纯穿孔修补术4例；穿孔修补术后3～4周行二期根治性手术2例；穿孔修补加胃、空肠造瘘及胃空肠吻合术2例；姑息性胃大部切除术11例；胃癌根治术5例。患者术后平均生存时间分别为（4±5）、（6±9）、（12±7）和（25±9）个月。结论正确诊断及选择合理术式是降低胃癌急性穿孔病死率、提高患者术后生存率及生命质量的关键。不同的病理分期可能是决定预后的重要因素。

Objective To explore the diagnosis, treatment and prognosis of acute perforation of gastric cancer. Methods The clinical data of 24 patients with acute perforation of gastric cancer who had been admitted to Guangzhou General Hospital of PLA from July 1996 to December 2008 were retrospectively analyzed. Results Of all patients, 4 were treated by perforation repair, 2 by perforation repair combined with gastrojejunostomy, 11 by palliative subtotal gastreetomy, 2 by radical gastrectomy, and 5 by radical gastrectomy after perforation repair. The mean survival time of patients treated by perforation repair, perforation repair combined with gastrojejunostomy, partial gastrectomy and radical gastrectomy were （4 ±5）, （6 ±9）, （12 ±7）, and （25 ±9） months, respectively. Conclusions Early diagnosis and reasonable operation are the keys to decrease the mortality and increase life quality for patients who suffered from acute perforation of gastric cancer. Different pathologic stages maybe an important factor in deciding the prognosis.