胃癌急性穿孔临床病理分期的特点以及手术方式

Clinical pathological staging feature and surgical procedures of acute perforation of gastric carcinoma

目的分析胃癌穿孔的临床病理分期特点和手术方式的关系。方法对我院2000年1月至2011年10月收治的44例胃癌急性穿孔患者的临床资料进行回顾性分析。分析不同的临床病理分期和手术方式的相关性以及对预后的影响。结果穿孔更多见于胃癌的Ⅲ～Ⅳ期。44例胃癌穿孔患者临床病理分期Ⅱ期(T4aN0M02例)2例,Ⅲ期(T4aN1-2M05例,T4bN0-1M014例)19例,IV期(T4aN1-3M17,T4bN1-3M116例)23例。16例(36.4%)行单纯穿孔修补术,其中Ⅲ期6例,IV期10例,19例(43.2%)行姑息性手术,其中Ⅲ期6例,IV期13例,4例(9%)一期根治性切除术中,II期1例,Ⅲ期3例,另外5例(11.4%)按损伤控制外科(DCS)原则行简单修补术后2周内行根治性胃切除术,其中II期1例,Ⅲ期4例。结论胃癌穿孔常发生于进展期胃癌,其手术方式不仅和临床病理分期有一定的相关性,还和患者的一般情况,是否合并休克等相关,对患者综合、合理的判断,选择合适的手术方法,可使部分患者获得根治机会,延长生存时间。

Objective To analyse the clinical pathology in the patients with perforation of gastric cancer （PGC） and the surgical procedures. Methods The clinical data of 44 PGC patients who admitted in our department of general surgery from Jan. 2000 to Oct. 2011 were selected as the object of this study. A retrospective analysis was done on clinical pathology stage and different surgical procedures. Results Of 44 cases, There were 2 cases in II stage （4aNOM0 2）, 19 in Ⅲ stage （T4aN1-2M0 5, T4bN0-1M0 14） and 23 in IV stage （T4aN1-3M1 7, T4bN1-3M1 16）. More PGC patients appeared in Ⅲ～Ⅳ stage and were infiltrated into chorion or subserosa （T4a-b）. In the 44 PCG patients, simple suture was performed in 6 cases in Ⅲ stage and 10 in Ⅳ stage. Palliative resection was in 6 cases in Ⅲ stage and 10 in Ⅳ stage and radical resection was in 6 cases in Ⅲ stage and 10 in Ⅳ stage. Another 8 patients （one in Ⅱ stage, 4 in Ⅲ stage and 3 in Ⅳ stage） were performed defined reoperations in two weeks after simple suture on preference of damage control surgery （DCS）. Conclusion Perforation of gastric carcinoma is observed mainly in advanced tumors. The choice of surgical procedures for these patients is associated with general conditions and complications. These patients should be performed situable surgical procedures to earn the chance of palliative resection or radical resection to extend their live time.