Kim Hyung Suk, Lee Jun Ho, Kim Min Gyu
Department of Surgery, Hanyang University Guri Hospital, 153, Gyeongchun-ro, Guri, 471-701, Korea.
Department of Surgery, Hanyang University Guri Hospital, Hanyang University School of Medicine, Seoul, Korea.
Surg Endosc. 2021 Aug;35(8):4206-4213. doi: 10.1007/s00464-020-07902-z. Epub 2020 Aug 28.
Gastric cancer perforation is rare and difficult to distinguish from gastric ulcer perforation before surgery. Peritonitis caused by gastric perforation requires emergency surgery. The optimal surgical strategy for gastric perforation has not been established.
Data from 43 patients who underwent primary gastrectomy with curative intent for gastric perforation between June 2010 and November 2019 were reviewed. Patients were classified into gastric ulcer and gastric cancer groups. Early surgical outcomes and overall survival were assessed.
There were no significant differences in clinical characteristics between the two groups except regarding preoperative shock. Laparoscopic gastrectomy was performed in 35 of 43 patients. There were no conversions to open surgery. The surgical findings demonstrated that the gastric cancer group had larger mass lesions with significantly larger perforations than did the gastric ulcer group. There were no significant differences in early surgical outcomes. Severe postoperative complications occurred in nine patients, five of whom died within one month of surgery. The majority of patients (90%) had stage III or IV gastric cancer. The 5-year survival rate was 19.5%.
We found no definitive differences in clinical characteristics distinguishing gastric cancer from ulcers. Considering our surgical outcomes, laparoscopic primary gastrectomy performed by an expert is a useful technique for emergency gastric perforation. However, unless an expert is available, caution should be used when selecting laparoscopic primary gastrectomy with curative intent as a surgical method.
胃癌穿孔较为罕见，术前难以与胃溃疡穿孔相鉴别。胃穿孔所致腹膜炎需要紧急手术。目前尚未确立胃穿孔的最佳手术策略。
回顾了2010年6月至2019年11月间43例因胃穿孔接受根治性原发性胃切除术患者的数据。将患者分为胃溃疡组和胃癌组。评估早期手术结果和总生存期。
除术前休克外，两组临床特征无显著差异。43例患者中有35例行腹腔镜胃切除术，无中转开腹手术。手术所见显示，胃癌组肿块病变较大，穿孔明显大于胃溃疡组。早期手术结果无显著差异。9例患者发生严重术后并发症，其中5例在术后1个月内死亡。大多数患者（90%）为Ⅲ期或Ⅳ期胃癌。5年生存率为19.5%。
我们发现区分胃癌和溃疡的临床特征无明确差异。考虑到我们的手术结果，由专家实施的腹腔镜原发性胃切除术是治疗紧急胃穿孔的一种有用技术。然而，除非有专家可用，在选择有根治意图的腹腔镜原发性胃切除术作为手术方法时应谨慎。
