胃癌穿孔的外科治疗

Surgical therapy for perforated gastric carcinoma

目的探讨胃癌穿孔患者合理手术术式的选择及其适应证 .方法复习 1983～ 1999年间在我科治疗的 26例胃癌穿孔患者的临床和病理特点及手术方式 ,分析手术死亡及生存期的相关因素 .结果胃癌穿孔患者大多为高龄 ,均为进展期胃癌 .行胃切除手术的 9例患者其病理分期Ⅰ、Ⅱ期各占 2例 ,Ⅲ期 5例 .本组手术死亡率 (术后 30 d以内 )为 27% ,其中穿孔修补术者 17例死亡 6例 ,胃癌切除术者 9例死亡 1例 .死亡原因为脏器功能衰竭和局部再穿孔 .术后穿孔修补术者生存 3～ 7个月 ,胃癌切除术者为 14～ 38个月 .结论 (1)胃癌切除加 D1淋巴结清扫是胃癌穿孔合理的外科治疗方法； (2)年龄 75岁以上 ,穿孔时间 12 h以上 ,术前有休克及伴有严重内科疾病为手术风险因素 ,存在 2项或以上者 ,应行局部修补加引流术 .

Objective To investigate the indications and suitable surgical procedures for perforated gastric carcinoma(PGC). Methods Clinical and pathological data of 26 patients with PGC from 1983 to 1999 were reviewed.The related factors of mortality and survival time were analyzed. Results Most patients with PGC were elder ones with advanced stage tumor.Nine cases underwent gastrectomy,including 2 patients with stageⅠ andⅡ tumors respectively,and 5 stageⅢ tumors.The postoperative mortality rate(less than 30 days)was 27% ,which 6 of 17 cases died in local repair group and 1 of 9 in gastrectomy group. The causes of death were organs failure and local reperforation.the survival rate of local repair group was 3～ 7 months and gastrectomy group was 14～ 38 months. Conclusions (1)The proper surgical procedure for PGC is gastrectomy with D1 lymph node clearance.(2)The risk factors of operation include age over 75 years,standing time of perforation more than 12 hours,preoperative shock and concomitant serious medical illnesses.Local repair and drainage should be performed when a patient has two or more risk factors.