穿孔胃瘤的外科治疗
Matheus Felipe Ferreira Aguiar1, Marina Alessandra Pereira1, Andre Roncon Dias1
1Department of Gastroenterology, Instituto do Cancer, Instituto do Cancer, Hospital das Clinicas, HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 01249000, Brazil.
World journal of gastrointestinal surgery
|December 8, 2025
概括
穿孔胃癌 (PGC) 的管理是具有挑战性的. 胃切除术,当可行时,显著改善了与PGC患者的简单穿孔修复相比的生存结果.
科学领域:
- 在瘤学瘤学.
- 外科胃肠道外科手术
- 胃肠道瘤学 胃肠道瘤学
背景情况:
- 穿孔胃癌 (PGC) 是一种罕见的,危及生命的手术紧急情况.
- 对于PGC的最佳手术管理仍然存在争议,来自大量西方中心的证据有限.
- 本研究解决了对PGC的基于证据的管理策略的需求.
研究的目的:
- 评估穿孔胃癌 (PGC) 患者的手术和生存结果.
- 基于初始治疗策略的结果进行比较:胃切除术与初级穿孔修复.
- 为了确定影响PGC患者生存的因素.
主要方法:
- 在2009年至2024年期间接受治疗的36名PGC患者的回顾性队列研究.
- 手术策略被归类为胃切除术或初级穿孔修复.
- 分析的结果包括30/90天死亡率,并发症和整体存活率 (OS).
主要成果:
- 10名患者 (27.8%) 进行了胃切除术,而26名 (72.2%) 接受了穿孔修复.
- 穿孔修复组的扩散型和差异化瘤的发病率更高.
- 胃切除组的整体存活率明显更好 (中位数为8.8个月与0.5个月,P=0.002).
- 多变量分析证实胃切除术是改善生存率的独立预测因子 (P=0.026).
结论:
- 胃切除术,无论是立即的还是延迟的,对于PGC患者来说,与单独进行局部穿孔修复相比,提供了更高的生存率.
- 这些发现支持胃切除术作为在PGC临床上可行的首选手术方法.
- 进一步的研究可能会完善最佳PGC管理的选择标准.
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