目的探讨胃癌穿孔的手术时机及术式选择。方法对我院1985年1月至2000年12月间急诊收治的64例胃癌穿孔患者的资料进行回顾性分析。结果保守治疗后行择期手术5例； 59例行急诊手术，其中行根治性切除术22例，姑息性切除术10例，穿孔修补后3周内二期行根治性手术6例，行单纯穿孔修补术14例，穿孔修补+短路手术7例。本组手术后30天内死亡6例，死亡率为9.4%，58例中获随访52例，随访5年，失访6例，其中根治性手术、姑息性切除、单纯穿孔修补和穿孔修补+短路手术者平均生存期分别为31个月、18个月、5个月和7个月。结论合理的手术时机及术式选择是延长患者生命和提高患者生存质量的关键所在。
Considering the problems such as reposition limited, easily detached and singly fired of the existing clip products, we developed an endoscopic multiple-clip applier which can apply 4 clips fired successively at a time. The instrument also equipped with an independent grasper which can be used to clamp target tissues. In order to explore its feasibility and effectiveness of endoluminal closure of gastric perforation, 22 pig stomachs were making a 1 cm full-thickness incision from outside and closed by multiple-clip applier (n=12) in vitro. Outcome was measured by bursting pressure and compared with negative control (n=5) and hand suture (n=5). We set a threshold pressure value (10 mm Hg) for a secure closure. Except 2 cases of invalid data, the mean bursting pressures of negative control, multiple-clip applier, hand suture were (1.5±0.3) mm Hg, (46.0±7.1) mm Hg, and (72.5±7.7) mm Hg, respectively. The results showed that bursting pressure of multiple-clip applier was significantly higher than that of negative control (P＜0.05) and threshold value. Multiple-clip applier can be served as an effective and safe device to perform the endoluminal closure of gastric perforation.
ObjectiveTo investigate the diagnosis and treatment value of multi-disciplinary team (MDT) model in patient with gastric perforation combined with hyperthyroidism crisis.MethodWe summarized the experiences of MDT model in treating one case of gastric perforation with hyperthyroidism crisis in the Fuling Central Hospital of Chongqing City on February 2019.ResultsThis patient had a history of hyperthyroidism and didn’t receive systemic treatment, diagnosing as acute diffuse peritonitis and perforation of hollow organs. After MDT discussions and a series of treatments, including anti-infection, control of heart rate and hyperthyroidism, this patient underwent surgical treatment of gastric peptic ulcer perforation, during and after the surgery, this patient suffered from hyperthyroid crisis. The surgery was successful, with the operation time was about 110 min, and the blood loss was about 50 mL. There was no side injury occurred without blood transfusion, and the patient was cured and discharged on 20 days after operation. The patient was followed up for about 1 year, and the general condition and life returned to normal.ConclusionMDT discussion is a very helpful way in the treatment of gastric perforation combined with hyperthyroidism crisis and can give a better outcome.