根治术与姑息切除术对胃癌胃急性穿孔、合并幽门梗阻及急性大出血的疗效比较

Efficacy of Radical Gastrectomy and Palliative Resection for Acute Gastric Perforation,Acute Bleeding and Pyloric Obstruction in Gastric Cancer

目的比较胃癌根治术与姑息切除术在治疗胃癌患者急性穿孔、合并幽门梗阻及急性大出血三种并发症的临床疗效及效果。方法回顾性分析根治术与姑息切除术治疗胃癌患者的临床资料,包括胃急性穿孔患者36例、急性大出血24例、合并幽门梗阻者24例。根据患者实际病情采用急诊胃癌根治术或姑息切除术,比较两种术式的手术时间、切口长度、排气时间、进食时间、住院时间和术后并发症,并分别于术后1年、3年、5年对患者进行随访,统计患者的生存率。结果姑息组平均手术时间(2.86±0.46)h,根治组手术平均时间(4.3±0.21);两组比较t=4.642,P=0.000;姑息组切口平均长度(5.63±0.45),根治组平均长度(18.31±2.5)cm,两组比较t=-35.807,P=0.000;姑息组平均排气时间(4.85±0.05)d,根治组平均排气时间(3.66±0.98)d,两组相比t=-2.99,P=0.001;姑息组平均进食时间(4.76±0.64)d,根治组平均进食时间为(3.16±0.68)d,两组相比t=-3.109,P=0.002;姑息组平均住院时间为(19.98±1.24)d,根治组平均住院时间为(10.75±1.12)d,姑息组的住院时间比根治组的住院时间长,两组相比t=0.46,P=0.014。姑息组术后并发症发生8例(19.05),根治组术后并发症发生4例(9.52),两组比较有统计学差异(P<0.05)。胃癌根治术组中胃急性穿孔者1、3、5年生存率分别为75.00%、50.00%、18.75%,合并幽门梗阻者1、3、5年生存率分别为64.28%、35.71%、7.14%,急性大出血者1、3、5年生存率分别为75.00%,33.3%、16.67%)。姑息切除术组中胃急性穿孔者1、3、5年生存率分别为50.00%、10.00%、0,合并幽门梗阻者1、3、5年生存率分别为50.00%、10.00%、0,急性大出血者1、3、5年生存率分别为50.00%、8.33%、0。结论胃癌根治手术治疗胃癌并发胃急性穿孔、幽门梗阻、急性大出血临床疗效较姑息切除术效果好,值得推广。

Objective To compare the clinical efficacy and effectiveness of radical gastrectomy and palliative resection in the treatment of patients with acute gastric perforation,pyloric obstruction and acute bleeding.Methods A retrospective analysis of radical surgery and palliative resection of clinical data of patients with gastric cancer,including acute gastric perforation 36 patients with acute bleeding in 24 cases,24 cases merge pyloric obstruction.According to the actual condition of patients using emergency gastrectomy or palliative resection,operation time,incision length,exhaust time,eating time,length of hospital stay and postoperative complications of the 2 groups were compared,and were followed up respectively in 1,3 and 5 years,survival rates were analyzed.Results Operative time in palliative group was（ 2.86 ± 0.46） h,and in the radical group was（ 4.3 ± 0.21）; t =4.642,P = 0.000; average cut length in palliative group（ 5.63 ± 0.45）,and in the radical group was（ 18.31 ± 2.5） cm,compared the 2 groups,t =- 35.807,P = 0.000; in palliative group,the average exhaust time was（ 4.85 ± 0.05） d,and in the radical group was（ 3.66 ± 0.98） d,compared the two groups,t =- 2.99,P = 0.001; average eating time in palliative group was（ 4.76 ± 0.64） d,and in the radical group was（ 3.16 ± 0.68） d,compared the two groups,t =- 3.109,P = 0.002; average hospital stay in palliative group was（ 19.98 ± 1.24） d,and in the radical group was（ 10.75 ± 1.12） d,hospital stay was longer in palliative group,t = 0.46,P = 0.014.There were 8 cases（ 19.05） of postoperative complications in palliative group,4 cases（ 9.52） in the radical group,There were significant differences（ P 0.05） between the 2 groups.In radical gastrectomy group,1,3,5-year survival rates of acute gastric perforation patients were 75.00%,50.00%,18.75%,1,3,5-year survival rates of mergepyloric obstruction patients were 64.28 %,35.71 %,7.14 %,1,3,5-year survival rates of acute bleeding patients were 75.00%,33.3%,16.67%.In palliative group,1,3,5-year survival rates of acute gastric perforation patients were 50.00%,10.00%,0,1,3,5-year survival rates of merge pyloric obstruction patients were 50.00%,10.00%,0,1,3,5-year survival rates of acute bleeding patients were 50.00%,8.33%,0.Conclusion Gastric cancer radical surgery in the treatment of gastric cancer complicated with acute perforation of stomach,pyloric obstruction,acute hemorrhage is effective,and it is worthy of promotion.