老年人胃癌急性穿孔62例诊治分析

Diagnosis and Therapy of Senile Patients with Acute Perfarated Gastric Cancer

目的探讨老年人胃癌急性穿孔的诊断和治疗。方法 62例老年胃癌穿孔患者进行诊断和治疗的回顾性分析。结果老年胃癌穿孔均为进展期溃疡型癌,病理以低分化或未分化腺癌多见(37/62,59.8%),全组62例行单纯穿孔修补19例,姑息性胃癌切除28例,胃癌根治切除15例;3种术式术后并发症发生率分别为72%、42%、55%,术后平均生存时间分别为6个月、18个月、27个月,全组3例死亡,2例为单纯穿孔修补病例,死亡原因局部再穿孔,1例为姑息切除术后脏器功能衰竭。结论胃癌穿孔的老年人全身情况差,存在邻近器官转移或浸润。术中应提高对本病的认识和警惕性,应积极手术治疗,尽可能行姑息性或根治性胃癌切除术。

Objective To investigate surgical diagnosis and therapy of elderly patients with acute perfarated gastric cancer（ APGC ）. Methods the clinical date of 62 elderly patients with APGC were retrospectivsly analyzed. Results Most senile patients with APGC were advanced ulcerative cancer. Sixty-two cases （ 59.8% ） were of poorly differentiated adenocarcinoma. Ninety cases underwent simply suture of the perforation; Twenty-eight cases received palliative gastreetomy and fifteen cases radical gastrectomy. The average survivaltime of patients treated with simple repair of perforation, palliative gastrectomy and radical gastrectomy was 6,18and 27 months respectively and postoperative complication occurrence was 72%,42%,55% respectively. The causes of three death were two local reperforation in simply suture group and organ failure in palliative gastrectomy group. Conclusion Old age, poor general conditions, perforation and metastases are characteristics of perforating gastric carcinoma. Surgical treatment should be performed as soon as possible and emergency palliative or radical gastrectomy was the reasonable operative choice.