ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG VÀ KẾT QUẢ PHẪU THUẬT UNG THƯ DẠ DÀY THÙNG BÍT

Abstract

Aim of study: 1. Evaluation the clinical and paraclinical features of eroded gastric cancer perforation. 2. The surgical results of eroded gastric cancer perforation. Patients and methode: Retrospective study. Results: There were 25 patients, male 72%, female 18%; average age 64,6 years (range 48-85). Epigastric pain 96,0%, melena 45,8%, gastric outlet obstruction 41,6%. Eroded gastric cancer perforation (EGCP) located at lower third  of stomach in 72,0%, middle third in  12%, upper third  in 16%. The ajacent organs to be eroded were: Head of pancreas in 44,0%; D1-D2 portion of duodenum in 52%, hepato-duodenal ligaments and hepatic segments in 36,0%; Body of pancreas 32,0%; Mesentery  of  transversal  colon 32,0%. The average diameter of  EGCP 3,14 cm (0,5-6 cm); The average diameter of gastric tumor 6,8 cm (4-10cm). Surgical procedure: Curative gastrectomy and D2 lymph node dissection in 92,0%; Palliative gastrectomy in 8,0% (peritoneal metastasis), Duodenostomy for compression in 9 patients; Plastic surgery by round ligaments to stump of duodenum (duodenal stump  located  ajacent to ampulla  of Vater). No death intra and post operation. Complication (12%): 2 patients had stumpt leakage that healing by drainage under ultrasound. 1 patient had bleeding  post operation that had re operated. Histo pathology: Stage III (b-c) 80%; Stage IV  8,0%; Gastric lymphoma tumor 8,0%; Inflammatory myo fibroblastic tumor 4,0%. Conclusion: We concluded that: The average age of eroded  gastric cancer perforation was more than 60 years (this study was 64,6 Y), predominant in male (72,0%). The symptoms were epigastric pain associated with melena and gastric outlet obstruction. EGCP located  in lower third of stomach was elevated (72%  in  this study). The average diameter of gastric cancer hole was larger  than  free perforation (3,14 cm in this study) and the average gastric tumor diameter was  larger than that of  free perforation  (6,8 cm in this study). Curative gastrectomy with D2 Lymph node dissection was performed in 92,0% and palliative gastrectomy in 8% (in this study).  Duodenostomy was performed in 9 patients  whose the duodenal stump located ajacent to ampulla of Vater.  Plastic round ligament   to duodenal stump in case  of fragile duodenal wall and duodenal stump located ajacent to the ampulla of Vate  was performed in 5 patients.  No death per and post operation.  Complication in 12%. (Duodenal stump fistula in 2 patients who were  drained under ultrasound. One patient  bleeding post operation that had re operated). Histopathology: Stage III b-c in 80,0%, stage IV in 8,0%; Gastric lymphoma  tumor 8,0%; Inflammatory myo fibroblastic tumor 4,0%  in our study.