Aranha G V, Georgen R
Department of Surgery, Loyola Stritch School of Medicine, Maywood, Ill.
Surgery. 1989 Oct;106(4):758-62; discussion 762-3.
In a 10-year period, 26 patients with gastric linitis plastica were identified at our institution. The 26 fell into two groups: In group I (nonresection group) seven underwent laparotomy and biopsy, three laparotomy, biopsy, and jejunostomy, and three patients were not explored; in group II (resection group) eight patients underwent total gastrectomy, two subtotal (85%) gastrectomy, one total gastrectomy with thoracic esophagectomy, one total gastrectomy with segmental resection of the tranverse colon, and one total gastrectomy with subtotal pancreatectomy and splenectomy. There was one postoperative death in each group. In group II morbidity consisted of an anastomotic leak in one, pancreatic fistula in two, and pancreatitis in one patient. Mean survival of group I patients was 6.6 months. The mean survival of group II patients was 7.2 months. Patients who underwent total gastrectomy in the presence of peritoneal or liver metastasis lived 4 months. Those who underwent total gastrectomy in the presence of pancreatic involvement lived 4 months. Patients who underwent total gastrectomy for disease limited to the stomach and regional lymph nodes lived 13.6 months. Total gastrectomy for linitis plastica should be performed in those patients who have disease limited to the stomach or regional lymph nodes. Other patients should be offered alternative forms of treatment, including chemotherapy and radiation therapy.
在10年期间，我院共确诊26例皮革胃患者。这26例患者分为两组：第一组（非切除组），7例行剖腹探查及活检，3例行剖腹探查、活检及空肠造口术，3例未进行探查；第二组（切除组），8例行全胃切除术，2例行次全（85%）胃切除术，1例行全胃切除加胸段食管切除术，1例行全胃切除加横结肠节段切除术，1例行全胃切除加次全胰切除术及脾切除术。每组均有1例术后死亡。第二组的并发症包括1例吻合口漏、2例胰瘘和1例胰腺炎。第一组患者的平均生存期为6.6个月。第二组患者的平均生存期为7.2个月。存在腹膜或肝转移时行全胃切除术的患者生存期为4个月。存在胰腺受累时行全胃切除术的患者生存期为4个月。因疾病局限于胃和区域淋巴结而行全胃切除术的患者生存期为13.6个月。皮革胃的全胃切除术应在疾病局限于胃或区域淋巴结的患者中进行。其他患者应接受包括化疗和放疗在内的替代治疗方式。
