胃癌穿孔的外科治疗

目的 探讨胃癌穿孔患者外科手术治疗的效果.方法 回顾性分析37例胃癌穿孔行外科治疗患者的临床资料.姑息性胃大部切除术24例,胃癌根治术8例,穿孔修补术4例,未手术1例.结果 术前诊断率24.3%,误诊率75.7%.围手术期病死率为5.4%,其中穿孔修补死亡1例.行姑息性胃大部切除术,胃癌根治术,穿孔修补术者并发症发生率分别为41.7%,25.0%,75.0%;术后平均生存期分别为25,29,3,0个月;姑息性胃大部切除和胃癌根治术的疗效明显优于穿孔修补术和未手术.结论 对于胃癌穿孔的患者,全身状况许可者,可行一期胃癌根治切除或姑息性胃大部切除手术.

Surgical treatment of perforation of gastric |carcinoma

Objective: To study the outcome of surgical therapy of perforation of gastric cancer.
Methods: The clinical data of 37 cases with perforation of gastric carcinoma  which  underwent different surgical procedures were analyzed retrospectively. Among them, 24 cases underwent partial gastrectomy,8 cases underwent radical mastectomy,4 cases had repair of perforation. 1 case received non operative therapy.
Results: The preoperative diagnotic rate was 24.3%,and misdiagonsis rate was 75.7%. The perioperative mortality rate was 5.4%, including 1 case that underwent repair of perforation. The post operative  complication rate of patients undergoing palliative gastrectomy, radical gastric cancer operation and repair of perforation was  41.7%, 25.0% and 75.0%, respectively,and the mean survival time was 25 months, 29 months and 3.0 months, respectively.The partial gastrectomy and radical mastectomy patients had significantly better outcomes than those who underwent repair of perforation or received non operative therapy.
Conclusions:   For patients with perforation of gastric cancer with resectable lesions and who are in good general coaditon, a one stage radical gastric resection or palliative subtotal gastrectomy can be performed.