赵　冬　张振山　黄正宇

【摘要】 目的 探讨晚期胃癌合并幽门梗阻的诊断和治疗。方法 回顾性分析12例晚期胃癌合并幽门梗阻患者的诊断特点、手术原则和化疗方法。结果 围手术期死亡2例，其中胃肠吻合术1例，胃造瘘术1例。其余胃肠吻合术者5例术后生存3~9个月；姑息性肿瘤切除术者4例，术后平均生存1．5年；胃癌根治术(联合脏器切除)者l例，生存3．5年。腹腔灌注化疗比全身静脉化疗副反应轻，效果好。结论 晚期胃癌合并幽门梗阻诊断、治疗复杂。局部肿瘤减量手术辅以腹腔灌注化疗可以延长患者生存期，提高生活质量。

【关键词】晚期胃癌；幽门梗阻；手术；化疗

Report of 12 cases of late gastric carcinoma complicated with pyloric obstruction

ZHAO Dong,ZHANG Zhen-shan,HUANG Zheng-yu.Department of Surgery，Second Traditional Medical Hospital of GuangDong,GuangZhou 510095，China

【Abstract】 Objective To investigate the diagnosis and treatment of late gastric carcinoma with pyloric obstruction．Methods The diagnosis,surgical treatment principles and chemotherapies on 12 cases of late gastric carcinoma with pyloroehesis were retrospectively analyzed．Results Two cases died during operation including, one with gastroenteroanastomosis and the other one with gastrostomosis．The average survival time was 3~9 months of the other five cases with gastroenteroanastomosis．Four cases received palliative subtotal gastrectomy with the average survival time being 1．5 years．One case received radical gastrectomy with survival time being 3．5 years．The peritioneal perfusion might get slight side reactions and significant effect．Conclusion The diagnosis and treatment of late gastric carcinoma combined with pylorochesis is complicated．Palliative excision with peritioneal perfusion can obviously increase the survial rate and improve the quality of life.

【Key words】Late gastric carcinoma；Pyloric obstruction；Operation；Chemotherapy

幽门梗阻是晚期胃癌的严重并发症之一，病情复杂，治疗棘手。广东省第二中医院自1990年以来共收治晚期胃癌合并幽门梗阻患者12例，占同期胃癌总数的2．5%(12/480)。结合临床和文献资料，就其诊断和治疗结果分析如下。

1 临床资料

1．1 一般资料 本组12例，男8例，女4例，年龄46~78岁，平均60．5岁。全组患者均有中上腹不适病史。有明确上消化道溃疡病史10例(10/12)，其中2年以上者6例，2年以内者4例。发病前均无胃癌明确诊断。近期有明显恶液质表现，如进行性消瘦，食欲减退，低蛋白血症(10例)。上消化道

梗阻发病到人院10 h~10 d，表现以腹胀为主，有时有恶心呕吐。肛门停止排便10例，发展到肛门停止排气3例；出现酸中毒、水电解质平衡紊乱者5例，癌性腹水3例；术前通过影像学(CT，彩超)确诊4例。

1．2 治疗经过 全部患者经胃肠减压，补充水电解质，纠正酸碱平衡紊乱等内科治疗3~7 d。……