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。

Surgical therapy for perforated gastric carcinoma

Objective To investigate the diagnose and the indications and suitable surgical procedures for perforated gastric carcinoma (PGC). Methods Clinical and pathological date of 30 patients with PGC from 1990 to 2004 were reviewed. The related factors of mortality and survival time were analysed. Results Most patients with PGS were elder and with advanced stage tumor. The post operative mortality rate was 20%, 5 died in local repair group and 1 died in gastrictomy group .The causes of death were organs failure and local reperforation. The 3 - years survival rate was 12.5 % respectively. Conclusion The proper surgical procedure for PGC is gastritomy with Lymph node clearance,and local repair and drainage should be performed when a patient has the risk factors of operation with age over 60 years, standing time of perforation more than 12 hours, preoperative shock and concomitant serious medical illnesses.