急诊胃癌穿孔手术方式的选择

Selection of surgical modalities for gastric cancer perforation

目的探讨急诊胃癌穿孔手术方式的选择,为进一步优化治疗方案提供依据.方法选取行急诊胃癌手术治疗的38例胃癌穿孔患者,依据手术方式不同分为单纯穿孔修补组（修补组,18例）及胃癌根治术组（根治组,20例）.比较两组患者的术中出血量、手术时间、术后48h IL-6、TNF-α水平、术后住院时间、手术并发症发生率、术后生存率.结果修补组术中出血量明显少于根治组、手术时间明显短于根治组（P〈0.05）.两组患者术后48h IL-6及 TNF-α水平的差异均无统计学意义（均 P 〉0.05）.两组均无围手术期死亡患者,无二次手术患者.修补组并发肺部感染及切开感染的发生率均明显高于根治组（均 P〈0.05）,其他并发症发生率的差异均无统计学意义（均 P 〉0.05）.根治组患者生存率及中位生存时间均明显高于修补组（均 P〈0.05）.结论胃癌穿孔单纯修补术术后并发症较多且预后较差,对于一般情况尚可,穿孔时间短的患者应争取Ⅰ期手术,并强化围术期监护,有助于提高患者生存时间.

Objective To compare different surgical modalities for gastric cancer perforation. Methods Thirty eight pa-tients with gastric cancer perforation underwent emergent surgery in out hospital from January 2008 to January 2011, among them 18 patients received repair surgery and 20 patients received radical gastrectomy. The peri-operative bleeding, 48h-postopera-tive serum IL-6 and TNF-α levels, length of postoperative hospital stay, surgical complications and median survival time were compared between two groups. Results Peri-operative bleeding of repair group was less than that of gastrectomy group （P〈0.05）, the operation time of repair group was shorter than that of gastrectomy group （P〈0.05）, the postoperative hospital stay in repair group was shorter than that of gastretomy group （P〈0.05）. There were no significant differences in 48h-post-operative serum IL-6 and TNF-a levels between two groups （P 〉0.05）. The pulmonary infection and incision infection rate in repair group was significantly higher than that in gastrectomy group. The median survival time in repair group was 9 months and that in gas-trecotmy group was 18 months （P〈0.05）. Conclusion Repair surgery might cause more complications and results in poor prog-nosis for patients with gastric cancer perforation; so emergent gastrectomy is recommended for patients whose condition is per-mitted.