Kandel Bishnu Prasad, Singh Yogendra, Singh Keshav Prasad, Khakurel Mahesh
Department of Surgery, Tribhuvan University Teaching Hospital.
Department of Surgery, KIST Medical College, Kathmandu, Nepal.
JNMA J Nepal Med Assoc. 2013 Jul-Sep;52(191):489-93.
Gastric cancer perforation can occurs in advanced stage of the disease and is often associated with a high morbidity and mortality. Peritonitis due to perforation needs emergency laparotomy and different surgical procedures can be performed for definitive treatment. Surgical procedures largely depend on the stage of the disease and general condition of the patient. This study was carried out to evaluate the outcome and role of different surgical procedures in gastric cancer perforation.
Medical record of patients with gastric perforation, who were treated during ten years period, was reviewed retrospectively. Data regarding clinical presentation, surgical procedures, staging and survival of patients were obtained.
Features suggestive of diffuse peritonitis were evident in all cases. The majority of the patients underwent emergency surgery except one who died during resuscitation. The majority of patients were in stage III and stage IV. Surgical procedure includes simple closure and omental patch in five patients, simple closure and gastrojejunostomy in nine patients, gastrectomy in six patients and Devine's antral exclusion in one patient. Surgical site infection was the most common (45.5%) postoperative complication. Four patients died within one month of the surgery. Three patients who underwent gastrectomy survived for one year and one patient survived for five years.
Although gastric cancer perforation usually occurs in advanced stage of the disease, curative resection should be considered as far as possible.
胃癌穿孔可发生于疾病晚期，常伴有高发病率和死亡率。穿孔所致腹膜炎需要紧急剖腹手术，可采用不同的手术方法进行确定性治疗。手术方法很大程度上取决于疾病分期和患者的一般状况。本研究旨在评估不同手术方法在胃癌穿孔治疗中的疗效及作用。
回顾性分析了10年间接受治疗的胃穿孔患者的病历。获取了有关患者临床表现、手术方法、分期和生存情况的数据。
所有病例均有弥漫性腹膜炎的表现。除1例在复苏过程中死亡外，大多数患者接受了急诊手术。大多数患者处于III期和IV期。手术方法包括5例行单纯缝合和网膜修补术，9例行单纯缝合和胃空肠吻合术，6例行胃切除术，1例行Devine胃窦切除术。手术部位感染是最常见的（45.5%）术后并发症。4例患者在术后1个月内死亡。3例行胃切除术的患者存活1年，1例存活5年。
尽管胃癌穿孔通常发生于疾病晚期，但应尽可能考虑进行根治性切除。
