胃癌的紧急表现；预后和对服务规划的影响。
Emergency presentation of the gastric cancer; prognosis and implications for service planning.
机构信息
Academic Surgical Department, Barts and the London NHS Trust, Whitechapel, London (E1 1BB), United Kingdom.
出版信息
World J Emerg Surg. 2012 Sep 25;7(1):31. doi: 10.1186/1749-7922-7-31.
AIMS
To compare emergency and elective presentation of gastric cancer by mode of clinical presentation, initial stage, intervention and prognosis.
METHODS
Data were collected prospectively for all cases of gastric cancer presenting to a tertiary referral centre between 2003 and 2010. This was stratified by emergency and elective presentation and was analysed for mode of presentation, initial stage and outcome. Statistical analysis was performed using unpaired t-test and Chi2 test.
RESULTS
A total of 291 patients presented: Forty-two (14.43%) were emergencies and 249 (85.57%) elective presentations. Analysis of the emergency cohort showed 25 patients presented with obstruction (59.52%), 15 presented with haematemesis (35.71%) and 2 with perforation (4.76%).Eighteen of the emergency patients (45%) presented with stage 4 disease compared to 60 (25.42%) in the elective group (p < 0.005). Fourteen of the emergency patients were treated with curative intent (33.3%) compared with 130 (55.56%) in the elective group (p < 0.01). Over 6 years only 2 patients needed operation within 24 hours of presentation.Overall survival at one year for emergency patients was 48.3% compared to 63.4% in elective patients (p < 0.05). There were no survivors from the emergency group after 3 years but 32.46% of the elective patients survived (p < 0.02). Elective presentation with disease stage 1A-3B had a two year survival rate of 54.95% compared to only 20% in the emergency group (p < 0.05). Of patients who underwent operative intervention 67.44% of patients who presented electively survived to 2 years. This compared to just 25% presenting as emergencies (p < 0.001).
CONCLUSIONS
Emergency presentation of gastric cancer is rare; is associated with higher stage of disease at presentation and lower rates of operability. The necessity to perform emergency operation within 24 hours is exceedingly rare. Emergency presentation is a marker of poor long term outcome for equivalent cancer stage in non-advanced (stages 1A-3B) disease.
目的
比较胃癌的紧急和择期就诊表现，包括临床表现、初始分期、干预措施和预后。
方法
前瞻性收集 2003 年至 2010 年期间在一家三级转诊中心就诊的所有胃癌病例数据。根据紧急和择期就诊进行分层，并分析就诊方式、初始分期和结局。使用配对 t 检验和卡方检验进行统计学分析。
结果
共 291 例患者就诊：42 例（14.43%）为紧急就诊，249 例（85.57%）为择期就诊。对紧急就诊队列进行分析显示，25 例患者因梗阻就诊（59.52%），15 例患者因呕血就诊（35.71%），2 例患者因穿孔就诊（4.76%）。18 例紧急就诊患者（45%）分期为 4 期，而择期就诊患者中分期为 4 期的有 60 例（25.42%）（p<0.005）。14 例紧急就诊患者接受了根治性治疗（33.3%），而择期就诊患者中接受根治性治疗的有 130 例（55.56%）（p<0.01）。6 年来，仅有 2 例患者在就诊后 24 小时内需要手术。紧急就诊患者的 1 年总生存率为 48.3%，而择期就诊患者的生存率为 63.4%（p<0.05）。3 年后紧急就诊组无生存者，但择期就诊组有 32.46%的患者存活（p<0.02）。疾病分期为 1A-3B 的择期就诊患者的 2 年生存率为 54.95%，而紧急就诊组仅为 20%（p<0.05）。接受手术干预的患者中，67.44%的择期就诊患者存活至 2 年，而紧急就诊患者的这一比例仅为 25%（p<0.001）。
结论
胃癌的紧急就诊较为少见，与就诊时疾病分期较高和手术可能性较低相关。需要在 24 小时内进行紧急手术的情况极为罕见。紧急就诊是疾病非晚期（分期为 1A-3B）患者预后不良的标志。
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