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目的探讨胃癌穿孔患者的临床诊断及外科手术治疗方式的选择。方法回顾性分析38例胃癌急性穿孔患者的临床病理、手术方式及生存期资料。结果患者平均年龄65岁。病理分期Ⅱ期9例,Ⅲ期19例,Ⅳ期10例。13例作急诊胃切除术,手术病死率2.6%;10例先作穿孔修补术,术后3周作胃切除术,无手术死亡;15例行穿孔修补或加作胃空肠吻合术,无手术死亡;胃切除术后中位存活期23个月(10～50个月),胃穿孔修补者中位存活期6.3个月(3～12个月)。结论术中常规取标本活检可避免胃癌漏诊。早期诊断及正确术式可以降低病死率,单纯修补近期并发症多生存期短,强调尽可能施行Ⅰ期胃癌根治术或姑息性胃切除,可延长生存期。
Objective To investigate the clinical diagnosis and surgical treatment of gastric cancer perforation patients. Methods A retrospective analysis of 38 cases of gastric cancer patients with acute perforation clinical pathology, surgical methods and survival data. Results The average age of patients was 65 years. There were 9 cases in stage Ⅱ, 19 cases in stage Ⅲ and 10 cases in stage Ⅳ. Thirteen patients underwent emergency gastrectomy with a mortality rate of 2.6%. Ten patients underwent first perforation repair and three weeks after operation for gastrectomy. No operative death occurred. Fifteen patients underwent perforation repair or gastrojejunostomy without any surgical death ; The median survival time after gastrectomy was 23 months (10-50 months), and the median survival time of gastric perforation repair was 6.3 months (3-12 months). Conclusion Intraoperative routine biopsy specimens can avoid missed diagnosis of gastric cancer. Early diagnosis and correct surgical procedures can reduce the mortality, simple repair of short-term complications and more survival, emphasizing the implementation of radical gastrectomy or palliative gastrectomy, prolong survival.