老年人胃癌穿孔（附39例报告）

本文报告，我院１９７６～１９９３年期间收治老年人胃癌急性穿孔３９例，大都于发病后２４小时内就诊。均为急诊手术，除８例行胃大部切除外，余均行胃癌穿孔修补术或修补加捷径手术，出院后随访２５例，行胃切除７例，平均生存３９月；示经胃大部切除１８例，平均生存１２个月。我们认为，胃癌穿孔者，如病情允许下，最好选择胃癌根治性或姑息性切除术，本组一例，切除后存活７年。也可在修补后选择Ⅱ期手术，本组２例，分别于术后一个月、三个月后行Ⅱ期手术，前者行上半胃切除，后者行全胃切除，分别存活３年、２年。     

40例胃癌急性穿孔诊治临床分析

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40例胃癌急性穿孔病人采用不同形式的治疗.10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;16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10个月,9.8个月、14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,是胃癌穿孔患者的最佳治疗方案.     

胃癌急性穿孔24例诊治体会

目的：探讨胃癌穿孔的临床特点、诊断及治疗。方法：分析我院24例胃癌穿孔患者临床资料，其中8例行单纯穿孔缝合修补，3例在穿孔修补术后4周内行Ⅱ期根治术，3例行穿孔修补加胃空肠吻合术，7例姑息性胃大部切除术，3例胃癌根治术。结果：本组因中毒性休克并多器官功能衰竭死亡2例，穿孔修补、姑息性胃大部切除术和胃癌根治后平均生存期分别为8个月、13个月、26．7个月。结论：早期诊断，选择正确手术方式及综合治疗是降低病死率，提高生存质量的重要因素。     

胃癌穿孔14例临床诊治分析

目的：观察胃癌根治术治疗胃癌穿孔的疗效。方法：对适宜作根治术的胃癌穿孔病例,进行根治术,并与作姑息性手术的胃癌穿孔病例对比其术后生存期。结果：作根治性手术的胃癌穿孔病例,其术后生存期明显长于作姑息性手术的胃癌穿孔者。结论：胃癌穿孔患者作根治手术,其术后生存期较长。因此,对就诊及时,全身状况较好,在剖腹中癌肿以及周围情况属可切除者,提倡施行根治性切除术。     

高龄老年胃癌的外科治疗

目的：面对日益增多的高龄老年胃癌，探讨适当的外科手术治疗。方法：回顾性分析我院普外科１９８４～１９９３年间２１２例７０岁以上高龄老年胃癌的临床资料及手术疗效。结果：高龄老年胃癌起病隐匿，常伴有出血、梗阻及贫血；绝大多数合并有其他疾病。手术证实绝大多数为中晚期胃癌，病理检查无明显特殊性。１６３例行胃癌切除术，切除率为７６．９％，根治性切除达５９．３％。姑息性切除平均生存期１１．８个月。临床早期胃癌（     

胃癌穿孔30例临床分析

目的 探讨胃癌穿孔患者的诊断、合理手术方式的选择及其适应证。方法 复习 1999-2004年间在我院治疗的30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影响因素。结果 穿孔患者大多为高龄，均为进展期胃癌。围手术期死亡率为20%，其中穿孔修补术者死亡5例,穿孔修补后二期行根治性胃大部切除者死亡1例，死亡原因以脏器功能衰竭和局部再穿孔为主。术后3 年生存率为12.5%。结论 胃癌切除加淋巴结清扫是胃癌穿孔根本的外科手术方法，穿孔单纯修补术可用于年龄60岁以上，穿孔时间超过12h，术前有休克及伴有严重内科疾病的患者。     

胃癌的化学药物治疗

当前我国胃癌的早期诊断率仍较低 ,据上海市的资料 ,胃癌确诊时的期别 ,Ⅰ期４．１ % ,Ⅱ期２１．８ % ,Ⅲ期３１．７ % ,Ⅳ期４２．２ %。不少病人明确诊断时 ,发病期已晚 ,丧失了手术治疗的机会 ,以致胃癌的实际预后较差。据北京市胃癌发病登记资料的随访 ,胃癌病人能存活５年以上者仅１４ %。全国胃癌协作组分析１１７３４例胃癌病人（１９８２年） ,其手术率为８１．８ % ,切除率为４９．７% ,根治性切除患者的５年生存率为３１．２% ,姑息性切除患者的５年生存率为１１．７ % ,未切除病人的平均生存时间仅为１２６．８天（４．１７个月…     

胃癌穿孔的诊断和治疗

目的 通过２４例胃癌穿孔病例临床资料的分析，对胃癌穿孔的诊断和治疗进行探讨。 方法 我院普外科１９９０年２月￣１９９８年５月收治的胃癌穿孔病例２４例，男２０例，女４例，年龄５２￣８４岁；术前诊断１４例，术中及术后诊断１０例。 结果 ６例行单纯穿孔修补加活检术，１８例行胃癌根治术或全胃切除术；大体类型多为溃疡型（２２／２４例，８７．５％）；病理多为低分化或未分化癌（１８／２２例，８１．８％）；穿孔修     

胃癌穿孔53例临床病理分析

回顾分析1990年1月6日～2003年2月18日入院治疗的53例胃癌穿孔患者的临床病理资料。40例(75．5％ 40／53)患者行根治性手术切除，死亡4例(10％ 4／40)，中位生存期34个月。13例(24．5％ 13／53)行姑息性手术，死亡8例(61．5％)，中位生存期8个月。回顾分析的结果显示对胃癌穿孔的治疗应区别对待，积极争取行根治性手术或先做穿孔修补术，术后3～4周再次手术切除肿瘤，情况差者亦应作修补术或加做引流术。     

老年人胃癌急性穿孔手术方式的探讨

目的:探讨老年人胃癌急性穿孔的临床特点和不同术式的选择指征.方法:回顾性分析收治的38例老年胃癌急性穿孔的临床资料.结果:单纯穿孔缝合修补术13例,平均生存时间为7个月;姑息性胃大部切除术17例,平均生存时间为18个月;胃癌根治术7例,平均生存时间24个月.结论:提高术前、术中确诊率,根据患者情况选择合适的术式,加强围手术期的处理是保障患者生命安全、降低老年胃癌穿孔的并发症、延长患者生存时间、提高生存质量的关键.     

18例胃癌穿孔的诊断和治疗

目的：研究胃癌穿孔患者一期切除治疗的临床疗效。方法：选择18例者行一期切除治疗。结果：一期切除治疗后，住院期间病死率为0，吻合口瘘占11.1%。五年生存率22.2%。结论：对胃癌穿孔患者，只要休克能纠正，身体状态许可，病灶可切除，行一期切除治疗是可行的。     

Two-stage radical gastrectomy for perforated gastric cancer

Introduction Perforation represents a severe complication of gastric cancer. Because it is rare, only few data are available regarding treatment and prognosis. Methods Patients with perforated gastric cancer were identified from two prospective registers of gastric cancer and of gastroduodenal ulcer. Results Between February 1982 and June 1999 23 patients with perforated gastric cancer were treated surgically. This corresponds to only 1.8% of 1273 patients presenting with gastric cancer, but to 14% of 161 patients presenting with gastric perforation during this time period. Overall, post-operative mortality was 13% (3/23). Initially, 21 patients had palliative operations. Two patients had a potentially curative procedure at the emergency operation and one of the two died post-operatively. Another six patients had potentially curative gastrectomy at a second stage and no patient died post-operatively. The 5-year overall survival was estimated at 50% for all eight curatively-treated patients. Median survival of palliatively treated patients was 6 months.Conclusions Perforation of the stomach should raise suspicion of malignancy, particularly in elderly patients. At the time of perforation radical gastrectomy with lymphadenectomy is mostly not advised, either because a diagnosis of gastric cancer is not confirmed or because the patient's condition does not allow extended surgery. In this situation it is suggested to consider a two-stage procedure and direct the primary operation at the treatment of perforation and peritonitis. Tumour staging can be completed when the patient has recovered and a radical operation with curative intent can be planned without compromising long-term prognosis. Our observations and a review of the literature confirm that perforation of gastric cancer does not preclude long-term survival per se in a substantial number of patients.     

Outcomes after emergency surgery for gastric perforation or severe bleeding in patients with gastric cancer

BACKGROUND AND OBJECTIVES: Free perforation and major bleeding in patients with gastric cancer are rare but serious conditions with potentially dangerous effects. To clarify the clinicopathologic characteristics of patients with these conditions and to determine the optimum management, we reviewed 16 cases of perforation and 13 cases of major bleeding in patients with gastric cancer who required emergency surgery. METHODS: We compared the clinical and histologic features of the patients with perforation and those with bleeding. Cox's multivariate regression analysis was used to compare survival rates between patients who underwent single-step surgery or a two-step radical procedure, between patients with stage I or II and stage III or IV cancer, between patients who underwent complete (R0) and incomplete (R1 or R2) resection, and between patients with bleeding and those with perforation. RESULTS: Many of the patients had advanced disease. There were no significant differences in clinicopathologic findings or survival between patients with gastric perforation and those with major bleeding. Patients who had major bleeding tended to have larger cancers. In the univariate analysis, gastrectomy (vs. no gastrectomy), R0 (vs. R1 or R2) resection, and lower stage (vs. higher stage) were highly correlated with improved survival time. CONCLUSIONS: Overall, patients with gastric cancers who underwent emergency gastrectomy had a poor prognosis, but it was better than that of patients who could not have gastrectomy because of the prXesence of advanced cancer. However, the survival rate was excellent in patients with early-stage cancer who underwent complete (R0) resection. We recommend complete resection when possible.     

Systemic chemotherapy does not increase the risk of gastrointestinal perforation.

BACKGROUND: Gastrointestinal perforation is a rare complication of gastric cancer. Although there is the perception of chemotherapy aggravating the perforation risk, the rate of perforation in patients with gastric cancer receiving chemotherapy is unknown. This study describes the incidence and clinical course of patients with gastric or gastroesophageal junction (GEJ) carcinoma who experience a perforation while receiving chemotherapy. PATIENTS AND METHODS: The records of patients with gastric or GEJ adenocarcinoma over a 6-year period who received chemotherapy for locally advanced or metastatic disease were reviewed. Extracted information included demographics, treatment received, and overall survival was calculated. RESULTS: 1032 patients at MSKCC received systemic cytotoxic chemotherapy for locally advanced or metastatic gastric or GEJ carcinoma; 11 patients experienced a perforation (1.1%, 95% CI 0.5-1.9%); 5/11 (45%) patients received further chemotherapy and had a median survival of 5.6 months. CONCLUSIONS: The rate of perforation in patients with advanced GEJ/gastric adenocarcinoma receiving chemotherapy is 1.1%, which is the same rate as in surgical series of patients presenting with perforation. Chemotherapy does not significantly add to the risk of gastrointestinal perforation.     

微波区域性热疗联合介入化疗治疗晚期胃癌的尝试(附25例分析)

目的观察微波区域性热疗联合介入化疗治疗晚期胃癌的临床效果。方法应用国产UHR2000型微波热疗机进行深部热疗同时联合介入化疗治疗胃癌25例。对照组采用单纯介入化疗22例。结果治疗组有效率(CR PR)为64%,对照组的有效率(CR PR)为31.8%,差异有统计学意义(P<0.05)。结论全身热疗联合介入化疗治疗能显著提高晚期胃癌的疗效。     

Clinicopathological features, surgical management, and disease outcome of perforated gastric cancer

BACKGROUND AND OBJECTIVES: Perforated gastric cancer is rare and generally not diagnosed preoperatively or intraoperatively, if a frozen section is unavailable. Therefore, the elucidation of its clinicopathological features and disease outcomes will help surgeons manage perforated gastric cancer. PATIENTS AND METHODS: The clinicopathological features, surgical management, and disease outcomes of 13 patients with perforated gastric cancer from March 1989 to May 2003 were retrospectively analyzed. Disease outcomes were analyzed in-depth based on tumor stage, depth of tumor invasion, operative curability, and three treatment groups. RESULTS: All 13 patients (median age of 72 years) received emergent laparotomy. Malignant gastric perforation was diagnosed intraoperatively in eight (61.5%) patients. Four patients whose frozen sections exhibited perforated gastric cancer underwent radical surgery with curative intent and were assigned to Group 1. Another four patients with overt distal metastases underwent palliative surgery and were assigned to Group 2. The remaining five patients were misdiagnosed as having benign gastric perforation and underwent local surgery; these patients were assigned to Group 3. All patients received follow-up for a median of 26 months. The survival rates for Stage I disease (P = 0.0342), T1/T2 tumors (P = 0.0342), and curative resection (P = 0.0012) significantly exceeded those of Stage III/IV, T3/T4 tumors, and non-curative resection. Additionally, the survival rates of Group 1 (P = 0.0067) and Group 3 (P = 0.0067) significantly exceeded those of Group 2. Stepwise logistic regression analysis revealed no significant predictor of prognosis. CONCLUSIONS: In resectable cases, one-stage radical gastrectomy with possible extensive lymphadenectomy should be encouraged if conditions allow. In cases of misdiagnosis, non-radical local surgery with curative resection is sufficient to treat early-stage cancer.     

Rare case of early mucosal gastric cancer presenting with metastasis to the bulbar conjunctiva

Early gastric cancer has an excellent outcome following surgical treatment. In particular, mucosal gastric cancer (m-cancer) very rarely results in metastatic dissemination and may be successfully treated by local surgical resection. We report a 64-year-old Japanese woman who presented with a recurrent cystic lesion on the left bulbar conjunctiva, with a biopsy specimen revealing metastatic signet-ring cell carcinoma. Gastrointestinal investigations revealed an early gastric cancer in the lesser curvature of the stomach. Biopsy specimen of the gastric lesion indicated poorly differentiated adenocarcinoma, which was identical to findings in the lesion in the bulbar conjunctiva. She underwent a distal gastrectomy and made an uneventful recovery. Histopathological analysis indicated a gastric signet-ring cell carcinoma that was limited to the mucosal layer, without evidence of lymphatic spread. Although the exact mechanism of metastatic dissemination to the bulbar conjunctiva is unclear, this case is very unusual, because ocular metastases almost invariably occur in the context of documented and established malignant disease. This is, to our knowledge, the first reported case of a patient with gastric mucosal cancer who presented with a conjunctival metastatic deposit and who subsequently received curative surgical treatment for both conditions. Received: November 5, 2001 / Accepted: February 5, 2002     

多西他赛联合奥沙利铂治疗晚期胃癌的临床观察

目的：观察多西他赛、奥沙利铂联合方案治疗晚期胃癌的疗效和安全性。方法：经病理证实的晚期胃癌患者26例,采用多西他赛联合奥沙利铂,治疗2-4个周期。按照RECIST标准和WHO毒性反应分级标准,分别评价疗效和毒性。结果：26例晚期胃癌患者中,获得CR 0例,PR 8例,SD 12例,PD 6例,总有效率30.8%,疾病控制率76.9%;中位TTP 6.3个月,中位总生存10.7个月,毒性反应主要为血液学毒性、消化道反应和神经毒性等。结论：多西他赛、奥沙利铂联合方案治疗晚期胃癌的客观疗效高,安全性好。