胃癌急性穿孔的外科诊治探讨

Diagnosis and Surgical Treatment of Acute Perforation of Gastric Carcinoma

目的探讨胃癌穿孔患者的临床诊断及外科手术治疗方式的选择。方法回顾性分析38例胃癌急性穿孔患者的临床病理、手术方式及生存期资料。结果患者平均年龄65岁。病理分期Ⅱ期9例,Ⅲ期19例,Ⅳ期10例。13例作急诊胃切除术,手术病死率2.6%;10例先作穿孔修补术,术后3周作胃切除术,无手术死亡;15例行穿孔修补或加作胃空肠吻合术,无手术死亡;胃切除术后中位存活期23个月(10～50个月),胃穿孔修补者中位存活期6.3个月(3～12个月)。结论术中常规取标本活检可避免胃癌漏诊。早期诊断及正确术式可以降低病死率,单纯修补近期并发症多生存期短,强调尽可能施行Ⅰ期胃癌根治术或姑息性胃切除,可延长生存期。

Objective To investigate the clinical diagnosis and the surgical treatment of perforated gastric cancer. Methods The clinical and pathological data, surgical treatment and survival time of 38 patients with acute perforation of gastric cancer were analyzed retrospectively. Results The mean age was 65 years in the 38 patients. There were 9 tumors in stage Ⅱ ,19 in stage Ⅲ and 10 in stage IV. Emergency gastrectomy was done in 13 patients, with the mortality of 2.6%. Ten patients received local repair at first, gastrectomy was done 3 weeks later without postoperative death. Perforation repair with or without gastroenterostomy was performed in 15 patients without operative death. The median survival time in gastrectomy group was 23 months（ ranged 10 to 50 months） and in repair group was 6.3 months（ ranged 3 to 12 months）. Conclusion Routine biopsy specimens can be taken to a- void missed diagnosis of gastric cancer. Early diagnosis and appropriate operative manner may be important for reducing the mortality. Simple suture closure of the perforation has more complications, and survival time is shorter. Primary radical gastreetomy or palliative gastrectomy for cancer should be emphasized as far as possible. The survival time is superior to other methods.