胃癌急性穿孔临床病理分期的特点以及手术方式

【摘要】 目的：分析评价胃癌穿孔的临床病理分期特点和治疗策略。方法：对我院 2000年1月至2011年10月收治的44例胃癌急性穿孔患者的临床资料进行回顾性分析。分析不同的临床病理分期和治疗对策的相关性以及对预后的影响。结果：44例胃癌穿孔患者临床病理分期II 期(T4aN0M0 2例)2例，Ⅲ期(T4aN1-2M0 5，T4bN0-1M0 14例)19，IV期 (T4aN1-3M1 7额，T4bN1-3M1 16例) 23 例，穿孔更多见于胃癌的III–IV 期，均侵犯浆膜或浆膜外（T4a-b）。16例（36.4%）行单纯穿孔修补术，其中Ⅲ期6例，IV期10例，16例（36.4%）行姑息性切除术，其中Ⅲ期6例，IV期10例，4例（9%）根治性切除术中，II 期1例，Ⅲ期3例，另外8例（18.2%）按损伤控制外科（DCS）原则行简单修补术后2周内行根治性胃切除术，其中II期1例，Ⅲ期4例， IV期3例，结论：胃癌穿孔常发生于进展期胃癌，其治疗策略以根治性手术或姑息性切除为主。

Clinical pathological staging feature and surgical procedures of acute perforation of gastric carcinoma

Objective To analyse the clinical pathology in the patients with perforation of gastric cancer(PGC) and the surgical procedures.Methods The clinical data of 44 PGC patients who admitted in our department of general surgery from Jan.2000 to Oct.2011 were selected as the object of this study.A retrospective analysis was done on clinical pathology stage and different surgical procedures.Results Of 44 cases,There were 2 cases in II stage(4aN0M0 2),19 in Ⅲ stage(T4aN1-2M0 5,T4bN0-1M0 14) and 23 in IV stage(T4aN1-3M1 7,T4bN1-3M1 16).More PGC patients appeared in Ⅲ-Ⅳ stage and were infiltrated into chorion or subserosa(T4a-b).In the 44 PCG patients,simple suture was performed in 6 cases in Ⅲ stage and 10 in IV stage.Palliative resection was in 6 cases in Ⅲ stage and 10 in IV stage and radical resection was in 6 cases in Ⅲ stage and 10 in IV stage.Another 8 patients(one in II stage,4 in Ⅲ stage and 3 in IV stage) were performed defined reoperations in two weeks after simple suture on preference of damage control surgery(DCS).Conclusion Perforation of gastric carcinoma is observed mainly in advanced tumors.The choice of surgical procedures for these patients is associated with general conditions and complications.These patients should be performed situable surgical procedures to earn the chance of palliative resection or radical resection to extend their live time.