Chao T C, Jeng L B, Jan Y Y, Wang C S, Chen M F
Department of Surgery, Chang Gung Medical College, and Chang Gung Memorial Hospital, Taipei, Taiwan, ROC.
Hepatogastroenterology. 1998 Nov-Dec;45(24):2157-60.
BACKGROUND/AIMS: Spontaneous gastroduodenal perforation is a rare and lethal complication in cancer patients receiving chemotherapy.
Data of 9 patients with spontaneous gastroduodenal perforation occurring during chemotherapy were reviewed.
All 9 patients were male with an average age of 54.4+/-2.5 years. The primary malignancies included 5 head and neck cancers, 2 esophageal cancers, 1 malignant lymphoma, and 1 hepatocellular carcinoma. Abdominal pain was the most common symptom. The average interval between the onset of symptoms and surgery was 2.9+/-0.7 days (range: 16 hours to 7 days). Perforation was located on the duodenum (6 patients) and on the lower part of the body of the stomach (3 patients). Simple closure of the perforation was performed on 8 patients, and subtotal gastrectomy on 1 patient. Culture of the ascitic fluid of 8 patients revealed E. coli, Klebsiella pneumoniae, streptococcus viridans, and enterococcus. Four patients (44.4%) had post-operative complications. The 30-day post-operative mortality was 44.4% (4/9). Three patients died of sepsis with multiple organ failure, and 1 died of hepatic failure. Age, anaemia, leukopenia, serum albumin levels, impaired renal or liver functions are not significant operative risk factors. Pre-operative shock is a significant factor in predicting operative mortality and complications.
High index with suspicion of the disease with early treatment may improve survival of cancer patients with spontaneous gastroduodenal perforation.
背景/目的：自发性胃十二指肠穿孔是接受化疗的癌症患者中一种罕见且致命的并发症。
回顾了9例化疗期间发生自发性胃十二指肠穿孔患者的数据。
9例患者均为男性，平均年龄54.4±2.5岁。原发性恶性肿瘤包括5例头颈部癌、2例食管癌、1例恶性淋巴瘤和1例肝细胞癌。腹痛是最常见的症状。症状出现至手术的平均间隔时间为2.9±0.7天（范围：16小时至7天）。穿孔位于十二指肠（6例患者）和胃体下部（3例患者）。8例患者行穿孔单纯缝合术，1例患者行胃大部切除术。8例患者腹水培养显示有大肠杆菌、肺炎克雷伯菌、草绿色链球菌和肠球菌。4例患者（44.4%）出现术后并发症。术后30天死亡率为44.4%（4/9）。3例患者死于败血症伴多器官功能衰竭，1例死于肝功能衰竭。年龄、贫血、白细胞减少、血清白蛋白水平、肾功能或肝功能受损不是显著的手术危险因素。术前休克是预测手术死亡率和并发症的重要因素。
提高对该病的怀疑指数并早期治疗可能会提高自发性胃十二指肠穿孔癌症患者的生存率。
