摘要
目的：探讨胃癌穿孔患者合理手术术式的选择及其适应征。方法：复习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相关因素。结果：胃癌穿孔患者大多为高龄，均为进展期胃癌。行胃切除手术的14例患者其病理分期Ⅰ、Ⅱ期各占3例，Ⅲ期8例。本组手术死亡率（术后30d以内）为23％，其中穿孔修补术者16例死亡6例，胃癌切除术者14例死亡l例。死亡原因为脏器功能衰竭和局部再穿孔。术后穿孔修补术者生存3～7个月，胃癌切除术者为14～40个月。结论：（1）胃癌切除加D1淋巴结清扫是胃癌穿孔合理的外科治疗方法；（2）年龄75岁以上，穿孔时间12h以上，术前有休克及伴有严重内科疾病为手术风险因素，存在2项或以上者，应行局部修补加引流术。
Objective： To investigate the indications and suitable surgical procedures for perforated gastric carcinoma（PGC）. Methods： Clinical and pathological data of 30 patients wich PGC from 1988 to 2001 were reviewed. The related factors of mortality and survival time were analyzed. Results：Most patients wich PGC were elder ones with advanced stage tumor. Fourteen cases underwent gastrectomy,including 3 patients wich Stage Ⅰ and Ⅱ tumors respectively, and 8 stage Ⅲ tumors. The postoperative mortality rate （less than 30 days） was 23%, 6of 16 cases died in local repair group and 1 of 14 gastrectomy group. The causes of death were organs failure and local reperforation, the survival rate of local repair group was 3 -7months and gastrectomy group was 14 ～ 40 months. Conclusions： （ 1 ） The proper surgical procedure for PGC is gastrectomy with D1 lymph node clearance. （2） The risk factors of operation include age over 75 years, standing time of perforation more than 12 hours, preoperative shock and concomitant serious medical illnesses. Local repair and drainage should be performed when a patient has two or more risk factors.
出处
《赣南医学院学报》
2006年第1期79-80,共2页
JOURNAL OF GANNAN MEDICAL UNIVERSITY
关键词
胃肿瘤
穿孔
Gastric neoplasm
Perforation
