40例胃癌急性穿孔诊治临床分析

Analysis of diagnosis and treatment for acute perforation of gastric cancer

目的 探讨胃癌急性穿孔的临床特点 ,指导临床诊治和提高疗效。方法 对本院 4 0例胃癌急性穿孔病人采用不同形式的治疗。 1 0例行单纯穿孔修补术 ,其中 4例在穿孔修补术后 3周、1例在穿孔修补术后 4周施行姑息性胃大部切除术 ,1例在穿孔修补术后 3周施行二期根治性手术 ;6例行穿孔修补和胃空肠吻合术 ;1 6例行姑息性胃大部切除术 ,其中 6例于术后 3周行腹腔淋巴结清扫术 ;4例行胃癌根治术 ;2例行胃造口 ,空肠营养性造口术 ;2例行单纯腹腔引流、灌洗术。结果 本组死亡 4例。单纯腹腔引流灌洗术。穿孔修补、胃大部切除、胃癌根治术后平均生存期分别为 1 0个月 ,9.8个月、1 4个月和 31个月。结论 早期诊断 ,综合治疗 ,注重护理 ,强调个性化原则 ,是降低病死率提高生存质量的重要因素 ;分期手术 ,先施行胃大部切除术 ,而后五淋巴结清扫术 。

Objective To investigate the clinical characteristics and give better guidance to the diagnosis, therapy, nursing, and improvement of prognosis for the patients suffering from acute perforation of gastric carcinoma.Methods 40 cases suffering from acute perforation of gastric carcinoma were collected in our hospital from 1998 to 2002, and of these patients, 10 were treated with repair of perforation, 4 with palliative gastrectomy for gastric carcinoma after repair of perforation in three weeks and 1 in four weeks, 1 with radical gastrectomy after repair of perforation in three weeks, 6 with repair of perforation and gastrojejunostomy at the same time, 16 with palliative gastrectomy, among which, 6 cases performed lymphadenectomy in three weeks, 4 with radical gastrectomy for gastric carcinoma, 2 with gastrostomy for nuitrition and 2 for continuous suction drainage and peritoneal lavage only.Results Four patients died during perioperative period. The life expectancy of patients treated with continuous suction drainage and peritoneal lavage only, repair of perforation ,palliative gastrectomy of radical gastrectomy for gastric carcinoma was 10, 9.8 ,14 and 31 months, respectively.onclusion Early diagnosis and great attention to whole treatment and nursing are important factors to reduce the mortality and increase life quality, and the two step surgery (gastrectomy first and lymphadenectomy later) often results in the best possible outcome for patients with perforated gastric cancer.