胃癌穿孔的诊断和治疗

DIAGNOSTIC AND THERAPEUTIC MEANS ON THE PERFORATED GASTRIC CANCER

目的通过２４例胃癌穿孔病例临床资料的分析，对胃癌穿孔的诊断和治疗进行探讨。方法我院普外科１９９０年２月～１９９８年５月收治的胃癌穿孔病例２４例，男２０例，女４例，年龄５２～８４岁；术前诊断１４例，术中及术后诊断１０例。结果６例行单纯穿孔修补加活检术，１８例行胃癌根治术或全胃切除术；大体类型多为溃疡型（２２／２４例，８７５％）；病理多为低分化或未分化癌（１８／２２例，８１８％）；穿孔修补平均生存时间６月，胃癌根治或姑息切除平均生存时间１７月。结论胃癌穿孔病例存在着一定的临床特点，如患者年龄偏大、一般情况差、溃疡及穿孔直径大等，处理上应积极手术治疗，尽可能行根治或姑息手术切除病灶。

PURPOSE On the diagnostic and therapeutic measures of perforated gastric cancer.METHODS Clinical analysis of 24 perforated gastric cancers treated in our hospital between February 1990 and May 1998.20 males,4 females,aged from 52 to 84.Preoperative diagnosis was made in 14 cases and operative diagnosis in 10 cases.RESULTS Single repair and biopsy was undertaken in 6 patients and gastrectomy in 18 patients.Pathologically,22/24 cases(87.5%) were of ulcerative cancer and 18/22 (81.8%) were of poorly differentiated.Medium survival time was 6 months in repair patients and 17 months in gastrectomy patients.CONCLUSION Old age,poor general conditions.larger ulcer and perforation size and metastases of patients are predispositive characteristics of perforated gastric cancer.Surgical intervention should be undertaken without delay and emergency gastrectomy is the better choice of operation.