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目的探讨胃癌穿孔患者合理手术术式的选择及其适应证 .方法复习 1983～ 1999年间在我科治疗的 26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 9例患者其病理分期Ⅰ、Ⅱ期各占 2例 ,Ⅲ期 5例 .本组手术死亡率 (术后 30 d以内 )为 27% ,其中穿孔修补术者 17例死亡 6例 ,胃癌切除术者 9例死亡 1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～ 38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 12 h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 selection and indications of reasonable surgical procedures for patients with gastric cancer perforation.Methods The clinical and pathological characteristics and surgical procedures of 26 patients with gastric cancer perforation treated in our department from 1983 to 1999 were reviewed and the related factors of operative mortality and survival were analyzed .Results Most of gastric cancer perforation patients are advanced, all of which are advanced gastric cancer.Gastric resection in 9 patients with pathological staging Ⅰ, Ⅱ each of 2 cases, Ⅲ 5 cases.The operative mortality (30 d after surgery ) Were 27%, including 17 cases of perforation repair in 6 cases, 9 cases of gastric cancer resection in 1 case.The cause of death was organ failure and local perforation.Postoperative perforation repair survival of 3 to 7 Month and gastric resection for 14 to 38 months.Conclusions (1) Gastric resection plus D1 lymph node dissection is a reasonable surgical treatment of gastric cancer perforation; (2) more than 75 years of age, perforation time of 12 h or more, preoperative shock And with serious medical diseases for surgical risk factors, there are two or more, local repair should be performed plus drainage.