胃癌急性穿孔的预后研究

Prognosis of Acute Perforation of Gastric Cancer

目的探讨胃癌急性穿孔的预后影响因素。方法选择2013年1月~2018年1月我院共收治的胃癌急性穿孔患者89例,其中行急诊手术切除38例,同时期行分期手术切除51例。收集急诊手术切除与分期手术切除治疗胃癌穿孔患者的临床资料,比较手术切除率、并发症及术后生存率,采用Kaplan-Meier法计算总体生存时间,作Log-rank检验。结果急诊手术切除与分期手术切除患者腹腔积液、病程、ALB水平、WBC水平、RBC、HGB、术中输血浆比较,差异有统计学意义(P<0.05);急诊手术切除与分期手术切除患者术后1,2,3和5年生存率比较,差异无统计学意义(P<0.05);急诊胃切除患者中位总体生存时间26.7个月,分期手术切除患者中位总体生存时间31.6个月,差异无统计学意义(P<0.05);年龄、ALB水平、肿瘤穿孔部位、肿瘤直径、UICC/TNM分期、淋巴结转移等6个因素与总体生存相关(P<0.05)。结论急诊胃切除术是治疗胃癌急性穿孔的可行方法,年龄、ALB水平、肿瘤穿孔部位、肿瘤直径、UICC/TNM分期、淋巴结转移6个因素是胃癌穿孔急诊胃切除术后并发症及生存影响因素。

Objective To investigate the prognostic factors of acute perforation of gastric cancer. Methods From January 2013 to January 2018, 89 patients with acute perforation of gastric cancer were enrolled in our hospital. Among them, 38 patients underwent emergency surgery and 51 patients underwent staged surgical resection. The clinical data of emergency surgical resection and staging surgical resection for gastric cancer perforation were collected. The surgical resection rate, complications and postoperative survival rate were compared. The overall survival time was calculated by Kaplan-Meier method and Log-rank test was performed. Results There were significant differences in the peritoneal effusion, duration of disease, ALB level, WBC level, RBC, HGB, and intraoperative plasma transfusion in patients undergoing emergency surgical resection and staged surgical resection (P<0.05). Emergency surgical resection and staging surgical resection After 1, 2, 3 and 5 years survival rate, the difference was not statistically significant (P<0.05);the median survival time of patients with emergency gastrectomy was 26.7 months, and the median survival time of patients with staged surgical resection was 31.6 months,the difference was not statistically significant (P<0.05);age, ALB level, tumor perforation site, tumor diameter, UICC/TNM stage, lymph node metastasis and other six factors were associated with overall survival (P<0.05). Conclusion Emergency gastrectomy is a feasible method for the treatment of acute perforation of gastric cancer. Age, ALB level, tumor perforation site, tumor diameter, UICC/TNM stage and lymph node metastasis are the complications and survival factors of gastric cancer perforation after emergency gastrectomy.