35例胃癌急性穿孔的外科诊治分析

Clinical Analysis of 35 Cases of Surgery Treatment for Acute Perforation of Gastric Carcinoma

目的探讨胃癌急性穿孔的临床特点以指导临床诊治,提高其疗效。方法回顾性调查宁波第一医院1998～2007年间在外科治疗的35例胃癌穿孔患者的临床资料,分析手术术式与生存期的相关性。结果大体类型多为溃疡型(28/35例,80%),病理多为低分化或未分化癌(27/35例,77.1%)。单纯穿孔修补术(或加胃空肠吻合术)11例,姑息性胃大部切除术13例,胃癌根治术11例。术后并发症发生率51.42%,手术死亡率5.7%,穿孔修补、姑息性切除、根治性切除术后1,3,5年生存率分别为9.09%、0%、0%;61.53%、30.79%、0%;81.81%、63.63%、36.36%。结论提高术前、术中确诊率,根据患者情况选择合适的术式很重要,首选行根治术或姑息性胃大部切除术。

Objective To explore the diagnosis and surgical treatment of the acute perforation of gastric carcinoma. Methods The clinical data of 35 patients with perforated gastric cancer that treated in surgery department of Ningbo First Hospi- tal from 1998 to 2007 were investigated retrospectively, and the relationship between operational pattern and survival period was analyzed. Results Pathological examination showed that 28 of the 35 cases （80%） suffered from ulcerative cancer, and lowly dif- ferentiated or undifferentiated cancer accounted for 77.1% （27/35）. 11 cases received simple perforation repair, 13 cases under- went subtotal gastrectomy, and 11 cases underwent radical gastrectomy. The postoperative complication rate was 51.42%, and mortality was 5.7%. 1 -,3 -, and 5 - year survival rates were 9.09% ,0, and 0 in the simple perforation repair group; 61.53% ,30.79% ,and 0 in subtotal gastrectomy group;81.81% ,63.63% ,and 36.36% in radical gastrectomy group. Conclusion It was important to raise the rate of confirmed diagnosis and strengthen the perioperative management. The first choice of operation was radical resection or palliative resection.