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胃癌并穿孔是一种临床少见病,发生率占胃癌总数2％～4％。我科自1987年～1997年共收治上消化道穿孔病人384人,剖腹探查证实老年胃癌穿孔22例,现分析报告如下。 1 临床资料 本组22例中男16例,女6例。年龄为60a～69a。术前诊断胃癌穿孔的仅有3例。本组病例经剖腹探查,见穿孔直径在0.5cmv1.7cm之间,其中以0.7cm为最多。穿孔部位胃窦部18例,胃体2例、贲门2例。急症行单纯穿孔修补18例占本组病人的81％,行胃癌根治术2例,先行穿孔修补再加胃空肠吻合术2例。术中均取活检证实。10例于单纯穿孔修补术后2wk～3wk之内又行胃癌根治术。Ⅰ期穿孔修补术后5例及Ⅱ期胃癌根治术后1例共6例切口感染,均经换药愈合。4例于Ⅰ期穿孔修补术后死于中毒性休克。5例切口感染者未行根治术。
Perforation of gastric cancer is a rare clinical disease, accounting for 2% to 4% of the total number of gastric cancer. In our department, 384 patients with perforation of the upper digestive tract were treated from 1987 to 1997. Peritoneal exploration confirmed 22 cases of perforation of elderly patients with gastric cancer. The analysis report is as follows. 1 clinical data in this group of 22 cases of 16 males and 6 females. The age is 60a to 69a. Only 3 cases of preoperative diagnosis of gastric cancer perforation. This group of patients through the exploratory laparotomy, see perforation diameter between 0.5cmv1.7cm, of which the most 0.7cm. Perforation site 18 cases of gastric antrum, 2 cases of gastric body, 2 cases of cardia. Emergency repair with simple perforation in 18 cases accounted for 81% of patients in this group, 2 cases of radical gastrectomy, first perforation repair and gastrojejunostomy in 2 cases. All biopsies were confirmed during the operation. Ten patients underwent radical gastrectomy within 2wk-3wk after simple perforation. A total of 6 incision infections were found in 5 patients with stage I perforation repair and 1 patient with stage II gastric cancer after radical surgery. All patients were healed by dressing change. Four patients died of toxic shock after a phase I perforation repair. Five patients with incision infections did not undergo radical surgery.