摘要：目的 探讨胃癌穿孔的临床特点、诊断与处理方法.方法 回顾性分析16例胃癌合并急性胃穿孔患者的临床资料以及手术方式.结果 16例行手术治疗患者中,5例行胃癌根治术,其中2例为D2根治术,3例为D1根治术;4例行姑息性胃切除术;6例行穿孔修补术;胃造瘘1例.手术早期死亡2例,其中1例为穿孔修补术,1例为姑息性胃大部分切除术,均死于感染性休克伴多器官功能衰竭.随访11例,1年内死亡5例,2年内死亡3例,3例存活3年以上.结论 术中常规取标本活检可避免胃癌漏诊.早期诊断及正确术式选择是降低病死率、提高生存质量的重要因素.姑息性切除术或根治性切除术可明显延长患者的生存期并改善预后. Abstract： Objective To investigate the principles of diagnosis and treatment of perforated gastric carcinoma. Methods Sixteen cases with perforated gastric cancer were analyzed retrospectively in the clinical data and operative manners. Results In 16 cases underwent operation, 5 cases were perfomed radical gastrectomy, 2 cases underwent D2 operation, 3 cases underwent D1 operation; 4 cases were perfomed palliativel gastrectomy. Six cases underwent perforation repair operation. 1 case underwent gastrotomy. Early death 2 cases, 1 case underwent local repair operation, 1 case was palliativel distal subtotal gastrectomy. Two cases died from septic shock accompanied with multiple organ dysfunction syndrome. Eleven cases were followed up, 5 cases died within 1 year, 3 cases within 2 years and 3 cases survived more than 3 years. Conclusions If intraoperative biopsy was taken, the missed diagnosis of gastric cancer can be avoided,and early diagnois and correct choice of surgical procedure may be important in reducing the mortality and improve the quality of life. The surgical methods of palliative resection and radical exision can prolong survival of patients with acute perforation of gastric carcinomas and improve their prognosis.

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