胃癌急性穿孔26例的临床分析

临床资料。一般资料本组共26例,其中男19例,女7例,年龄26-78岁,平均57岁,26例患者均有突发腹痛和腹膜炎体征。20例(77％)X线检查发现有膈下游离气体,术前诊断为胃癌穿孔的7例,疑诊胃癌穿孔5例,误诊胃十二指肠溃疡穿孔14例,6例术前伴有休克,所有病例均急诊手术治疗。     

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30例诊治体会

我院自1984～1990年共收治胃癌穿孔30例,其中男19例、女11例,年龄17～82岁,行急症胃癌根治术14例,姑息性切除加穿孔修补术16例。术后常规化疗,常用方案FM、FAM、FMC。随访时间1～3年,25例得到了随访,占总例数的83％,根治组平均存活22个月,姑息性切除包括修补手术均在12个月内死亡。作者认为,胃癌穿孔应以根治术为最妥,防止复杂的检查延误诊治,失去根治时机。     

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。     

胃癌穿孔29例临床分析

 胃癌穿孔是一严重并发症 ,穿孔一般较大 ,多难自行闭合 ,诊断、处理困难 ,且其预后远较良性溃疡穿孔为差。我科自 1992年元旦～ 2 0 0 0年 4月共收治胃癌急性穿孔 2 9例 ,均作了急诊手术治疗 ,现报告如下 :     

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

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.     

胃癌急性穿孔20例诊治分析

胃癌急性穿孔是一种少见的严重急腹症,其发生率为急腹症的1%[1],近30年来英文出版物中仅4篇文献涉及[1～4].穿孔性胃癌大多发生在疾病的进展期,病情急,腹腔细菌污染严重,同时存在癌瘤细胞播散可能,其处理远较良性溃疡病穿孔更为棘手.本院1980～1998年共收治胃癌772例,其中发生急性穿孔20例,穿孔率2.6%.为了提高对此种疾病的综合认识,阐明其治疗方案的选择,本文结合临床资料及有关文献进行分析.     

胃癌穿孔21例诊治临床分析

消化道穿孔是外科常见病，绝大多数为溃疡病所引起，近年来由于治疗溃疡病的药物疗效确切，使溃疡病发展至穿孔的病例日渐减少，而由于肿瘤引起之穿孔病例逐渐增多，应引起临床上的重视。我院自1984年11月至2002年11月共收治消化道穿孔患者318例，其中因胃癌引起穿孔的病例为21例，占6．6％。现结合文献报告如下。     

17例胃癌穿孔的诊断治疗体会

目的研究胃癌穿孔患者治疗方法的临床疗效。方法对17例胃癌穿孔的患者进行手术治疗并进行评价。结果治疗后，住院期间死亡率为0；胃肠吻合口瘘为11．8％；平均存活时间为18．3个月；行根治性手术者，平均存活36．2个月。结论对胃癌穿孔患者，只要休克能纠正，身体状态允许，病灶可切除，进行根治性切除治疗是积极的治疗方法。     

Long-term survival after perforation of advanced gastric cancer: Case report and review of the literature

Although the standard operation for early cancer of gastric cardia is proximal gastrectomy followed by jejunal interposition, we recently reported a simple and useful technique for proximal gastrectomy with gastric tube reconstruction. The operative procedures included resection of the proximal two-thirds of the stomach, followed by anastomosis between the esophagus and gastric tube, using a circular stapler (Proximate ILS 25; Ethicon, Cincinnati, OH, USA). The gastric tube was about 20 cm long and 4 cm wide. The patient a 76-year-old man had no reflux symptoms such as heartburn, retrosternal pain, and regurgitation. Endoscopy showed no evidence of reflux esophagitis, including mucosal redness, erosion, and ulceration. Ambulatory 24-h pH monitoring indicated that the pH of the lower esophagus was between 6 and 8 when the patient was upright and between 5 and 7 when he was in the supine position. There were nine reflux episodes during the day, and no reflux episode while he was asleep. The duration of each reflux episode was less than 1 min, and the total reflux time was 1 min in the 12-h day (0.1%). These data indicate that reconstruction by gastric tube may prevent esophageal reflux in patients who have undergone proximal gastrectomy for early cancer of the gastric cardia. Received for publication on Jan. 14, 1998; accepted on Apr. 1, 1998     

Combined modality treatment of gastric cancer

In a series of 46 patients with localized gastric cancer treated at Massachusetts General Hospital, problems with excessive acute or chronic toxicity due to combination treatment with irradiation (XRT) and chemotherapy (CT) were not seen. Forty of the 46 received combined treatment with 2 regimens: 1) Irradiation plus concomitant 3 days of 5-FU followed by maintenance 5-FU or combined drugs--26 patients; 2) In the other 14 patients, the sequence of irradiation and chemotherapy was altered. A single course of combined drug chemotherapy was given prior to irradiation and 5-6 additional courses were administered after completion of XRT (CT-XRT-CT). The drug combination was initially 5-FU-BCNU but this was changed to FAM (5-FU, Adriamycin, Mitomycin C). Irradiation was delivered to tightly contoured portals using shaped blocks to spare as much small bowel, kidney and marrow as possible while giving 4500-5200 rad in 25 to 29 fractions over 5 to 6 weeks. In this series, there were no cases of septicemia or any deaths related to treatment. A 3 year survival rate of about 20% was achieved for the total group of patients and 43% in the group with resection but at high risk for later failure. Our inability to improve these numbers is undoubtedly a result of dose limitations with external beam irradiation combined with a systemic failure problem. When irradiation is combined with surgical resection of all or a majority of tumor, both survival and local control appear to be better than in the unresected patient group. Only 4 of 29 patients (14%) with curative resection, or resection but residual disease, had later evidence of failure within the irradiation field as opposed to 6 of 9 or 66% in the group with unresectable disease.     

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.     

Comparison of laparoscopic versus open gastrectomy for gastric cancer

BackgroundThis study aimed to compare the short-term and long-term outcomes of laparoscopic gastrectomy (LG) and open gastrectomy (OG) for gastric cancer in a tertiary referral center in Hong Kong.MethodsTwo hundred and ninety-four consecutive patients with gastric cancer who underwent radical gastrectomy with curative intent between January 2008 and December 2015 were analyzed. Data was prospectively collected and reviewed. Propensity score matching was applied at a ratio of 1:1 to compare the OG and LG groups.ResultsAfter propensity score matching, operation duration (294.7 vs 231.8min, P < 0.01) was significantly longer while estimated blood loss (191.6 vs 351.0 ml, P = 0.01) was significantly less in LG group compared with OG. There were no significant differences in postoperative complications and mortality between LG and OG groups (postoperative complication rate, 35.2% vs 40.7%, P = 0.69; 90-day mortality rate, 1.9% vs 3.7%, P = 1.00). Three-year OS and 3-yr DFS of patients who underwent LG was not inferior to that of patients who had OG (P = 0.34; P = 0.51). However, there were significantly more peritoneal recurrences among the OG group than LG group (P < 0.01).ConclusionsLG has comparable outcomes for gastric cancer, even in advanced tumors. We could appropriately increase the proportion of laparoscopic gastrectomy for gastric cancer.     

残胃癌的外科治疗（附19例临床分析）

目的：探讨残胃癌的病因，外科治疗方法及对并发症防治。方法：整理分析本院１０年来收治残胃癌１９例的临床资料，对比根治性胃全切除及合并邻近脏器联合切除、姑息性切除、非切除各组患者的治疗效果。结果：本组１９例中，１２全和Ｂ－Ⅱ式切除术；残胃部呛切除后１年、２年、５年生存率分别为５８．３％、２５．０％、１６．７％。非切除病例均在５～６月内死亡。结论：行远侧胃切除，应争取作Ｂ－Ⅰ式切除术；对残胃癌应强调早期     

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。     

腹腔镜胃癌根治术与传统开腹手术在早期胃癌治疗中的应用效果比较

目的 探讨腹腔镜胃癌根治术与传统开腹手术在早期胃癌治疗中的应用效果.方法 依据手术方式将279例早期胃癌患者分为腹腔镜组(n=142)和开腹组(n=137),腹腔镜组患者接受腹腔镜胃癌根治术治疗,开腹组患者接受开腹胃癌根治术治疗.比较两组患者的围手术期相关指标、血清学指标[血清癌胚抗原(CEA)、糖类抗原19-9(CA...     

根治性远端胃大部切除胃十二指肠空肠“间置”吻合术（附23例报告）

本文结合ＢｉｌｌｒｏｔｈⅠ式手术优点，对２３例胃癌患者行胃远端根治性切除胃十二指肠空肠“间置”，取得了良好的效果。本术式通过８～１２个月随访，近期效果满意。基本上维持正常生理通道，减少胃肠功能紊乱和术后并发症，减少胆汁及小肠液的返流。符合胃癌根治术的原则，降低残胃癌的发生，改善患者的生存质量，延长生存期。本手术操作不太复杂，适用于Ａ、ＡＭ、ＭＡ区肿瘤的外科治疗。