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目的:对急诊胃癌穿孔腹腔镜手术方式的选择进行探讨,为进一步优化治疗方案提供依据。方法:选取笔者所在医院2008年6月-2013年6月经治的21例胃癌穿孔临床资料作为研究对象,所有患者的病历资料完整,术式选择、并发症发生情况和术后存活时间进行分析。结果:21例均成功行腹腔镜手术。3例行单纯腹腔镜修补术,12例行经腹腔镜胃癌根治术(Ⅰ期7例+Ⅱ期5例),6例行姑息性远侧胃大部切除术(Ⅰ期5例+Ⅱ期1例)。结论:胃癌穿孔患者,全身情况较好可耐受全麻及腹腔镜根治性切除者,可积极行Ⅰ期腹腔镜根治行切除术。无条件者行穿孔修补术后2-3周再施行Ⅱ期经腹腔镜胃癌根治术。
Objective: To explore the choice of laparoscopic emergency laparoscopic surgery for gastric cancer and provide the basis for further optimization of treatment options. Methods: The clinical data of 21 cases of gastric cancer perforation were selected from the hospital of our hospital from June 2008 to June 2013. The data of all the patients were complete, the operation choice, the complication and the postoperative survival time were analyzed. Results: All 21 cases were successfully performed laparoscopic surgery. 3 cases underwent simple laparoscopic repair, 12 cases underwent laparoscopic radical gastrectomy (7 cases of stage Ⅰ and 5 cases of stage Ⅱ), and 6 cases of palliative distal gastrectomy (stage Ⅰ 5 cases + stage Ⅱ 1 case). Conclusion: Patients with gastric cancer perforation, the general condition is better able to tolerate general anesthesia and laparoscopic radical resection, can be active Ⅰ laparoscopic radical resection. Unconditional perforation repair 2-3 weeks after the implementation of the second phase of laparoscopic radical gastrectomy.