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目的了解胃癌穿孔患者术后的生存情况,探讨影响预后的相关因素。方法采用Cox模型回顾性分析2000年7月—2011年7月收治的61例胃癌穿孔术患者的临床资料。结果患者术后中位生存时间120 d。1、3、5年生存率分别是31.15%(19/61)、3.28%(2/61)和0。对单因素Cox回归分析筛选差异有统计学意义的变量进行多因素Cox回归分析显示,与Ⅱ期胃癌比较,Ⅲ期(OR=4.875,P=0.040)和Ⅳ期(OR=9.386,P=0.006)胃癌穿孔患者的预后差。与一期根治术相比,行单纯修补术(OR=3.937,P=0.008)和姑息性胃切除术(OR=2.347,P=0.031)患者的预后较差。此外,合并疾病也是预后的危险因素(OR=4.337,P=0.002)。结论胃癌穿孔患者术后的预后不良,与胃癌TNM分期的关系最密切,手术方式首选一期根治术;而是否患有合并疾病是机体能否耐受手术的参考指标。
Objective To understand the postoperative survival of patients with gastric cancer perforation and to explore the related factors that affect the prognosis. Methods The clinical data of 61 patients with gastric cancer perforation admitted from July 2000 to July 2011 were retrospectively analyzed by Cox model. Results The median postoperative survival time was 120 days. The 1, 3, 5 year survival rates were 31.15% (19/61), 3.28% (2/61) and 0 respectively. Multivariate Cox regression analysis showed that there was significant difference between the two groups (P> 0.05), stage III (OR = 4.875, P = 0.040) Poor prognosis in patients with gastric cancer perforation. Patients undergoing simple repair (OR = 3.937, P = 0.008) and palliative gastrectomy (OR = 2.347, P = 0.031) had poorer prognosis than radical gastrectomy. In addition, co-morbidities were also risk factors for prognosis (OR = 4.337, P = 0.002). Conclusions The poor prognosis of patients with gastric cancer perforation after surgery is most closely related to the TNM staging of gastric cancer, and the first choice of surgical procedure is radical surgery. Whether the patient has the combined disease is the reference index of whether the body can tolerate the operation.