Kasakura Yuichi, Ajani Jaffer A, Fujii Masashi, Mochizuki Fumiro, Takayama Tadatoshi
Department of Gastrointestinal Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, USA.
Am Surg. 2002 May;68(5):434-40.
Perforated gastric carcinoma is rare; however, it is a serious condition associated with complications. To understand the proper management of this disease and to characterize its clinical course we reviewed available data on 16 patients with perforated gastric carcinoma. We collected data on the age and sex of the patients as well as operative findings and histological features of the primary tumor. The depth of invasion and presence of lymph node metastasis were also recorded. The Union Internationale Contre Cancer stage, extent of resection, and surgical method used were reviewed. We also reviewed published information on the management of perforated gastric carcinoma. The carcinoma was stage I in three cases, stage II in one case, stage III in three cases, and stage IV in nine cases. Many patients had distant metastases. Fourteen patients underwent gastrectomy. Two patients whose preoperative condition was poor died of surgery-related complications, but patients with early-stage carcinoma underwent an R0 resection (resection of the primary tumor with negative margins) and had minimal complications. We conclude that the outcome of patients who were able to undergo radical surgery was good and correlated with the stage of cancer. It is important to perform gastrectomy rather than repair the perforation first, and a proper lymphadenectomy should follow--thus a two-step surgery when necessary.
胃穿孔性癌较为罕见；然而，它是一种伴有并发症的严重病症。为了解该疾病的恰当治疗方法并描述其临床病程，我们回顾了16例胃穿孔性癌患者的现有数据。我们收集了患者的年龄和性别数据，以及原发肿瘤的手术所见和组织学特征。还记录了肿瘤浸润深度和淋巴结转移情况。对国际抗癌联盟分期、切除范围和所采用的手术方法进行了回顾。我们还查阅了已发表的关于胃穿孔性癌治疗的信息。3例患者为I期癌，1例为II期癌，3例为III期癌，9例为IV期癌。许多患者有远处转移。14例患者接受了胃切除术。2例术前状况较差的患者死于手术相关并发症，但早期癌患者接受了R0切除（切缘阴性的原发肿瘤切除）且并发症极少。我们得出结论，能够接受根治性手术的患者预后良好，且与癌症分期相关。先进行胃切除术而非首先修补穿孔很重要，必要时应进行适当的淋巴结清扫——因此必要时采用两步手术。
