胃癌急性穿孔的诊断与外科治疗

目的：探讨胃癌急性穿孔的诊断和外科治疗。方法：对我院1998年－1999年间45例胃癌急性穿孔患者的临床资料进行回顾性分析。结果：胃癌穿孔多见于高龄，均为进展期溃疡型癌，病理多为低分化或未分化腺癌（37／45例，82．2％），全组45例行单纯穿孔修补20例，姑息性胃癌切除10例，胃癌根治切除15例，3种术式术后并发症发生率分别为30％、10％、13％；术后平均生存时间分别为6．1个月、16个月、26个月，全组2例死亡均为单纯穿孔修补病例。死亡原因为脏器功能衰竭和局部再穿孔。结论：胃癌穿孔常表现为年龄偏大，全身情况差，溃疡及穿孔直径大，邻近器官转移或侵润等，术中应提高对本病的认识和警惕性，应积极手术治疗，尽可能行姑息性或根治性胃癌切除术。

Diagnosis and Surgical Treatment of Acute Perforation of Gastric Carcinoma

Objective:To investigate the diagnosis and surgical treatment of acute perforation of gastric carcinoma.Methods:The clinical data of 45 cases with acute perforation of gastric carcinoma which underwent different surgical procedures from 1988 to 1999 were analyzed retrospectively.Results:Most patients with acute perforation of gastric carcinoma were elder ones with tumor in advanced ulcerative stage.Thirty-seven cases(82.2%)were of poorly differentiated adenocarcinoma.Twenty cases underwent suture of the perforation;ten cases received palliative gastrectomy and fifteen cases radical gastrectomy.The average survival time of patients treated with simple repair of perforation?palliative gastrectomy and radical gastrectomy was 6.1?16 and 26 months respectively and postoperative complication occurrence was 30%?10%?13% respectively.Two cases died in simple repair group.The causes of death were organ failure and local reperforation.Conclusions:Old age,poor general conditions,large ulcer and size of perforation perforation and metastases are characteristics of perforating gastric carcinoma.Surgical treatment should be performed as soon as possible and emergency palliative or radical gastrectomy was the operation of choice.