ĐẶC ĐIỂM LÂM SÀNG VÀ KẾT QUẢ ĐIỀU TRỊ PHẪU THUẬT UNG THƯ DẠ DÀY THỦNG VÀ THỦNG Ổ LOÉT DẠ DÀY - TÁ TRÀNG TRÊN BỆNH NHÂN ĐANG ĐIỀU TRỊ BỆNH LÝ UNG THƯ

Abstract

Study aim: 1. Evaluate the clinical and paraclinical feature of gastric cancer perforation and gastroduodenal ulcer perforation in patient having cancer diseases. 2. The surgical results of gastric cancer perforation and gastroduodenal perforation. The results: There were 46 patients, male 91,3%, female 8,7%, mean age 59,71 years, Subgroup of gastric cancer perforation was 26 patients, subgroup gastroduodenal ulcer perforation was 20 patients; Of them, 76% had strong abdominal pain, rebound tenderness. Abdominal X ray showed subphrenic air in 35 patients. CT scan revealed intra abdominal air and liquid in 76% and thickened wall of stomach with intraabdominal lymph nodes in 22 patients. Operation performed: subtotal gastrectomy with D2 lymphadenectomy in 23 patients; Simple suture in one patients; Suture with drainage tube (procedure of Newmann) in one patient, total gastrectomy with  left pancreatic and splenectomy in 1 patient. Death and complication: - One died due to disseminated intravascular Coagulation on  8 nd day post gastrectomy, - One patient had intra-abdominal bleeding < 24h post operation (reoperation for hemostasis) - One had adhesive small bowel  obstruction < 1 month (reoperation) - One had  intra abdominal abscess that healing by ultrasound guide drainage. Histopathology: 65,4% had Stage III-IV of gastric cancer. Conclusion: The surgical procedure for gastric cancer perforation should be divided into 2 procedures: The first: simple suture of perforation and abdominal lavage for peritonitis. The second: radical gastrectomy and D2 lymphadenectomy in order to have the elevated R0 resection and low mortality and also elevated 5 year survival rate more than 50%. It is advisable not to do palliative gastrctomy or non-radical resection  due to peritonitis that could have high mortality and low rate  of 5 years survival. - For gastroduodenal perforation: Laparoscopic suture with lavage is operation of choice. 2/3 gastrectomy and ulcer excluded or excised  and duodenostomy  should be performed in bleeding and posterior duodenal ulcer perforation that eroded to gastroduodenal artery and head of pancreas.